{"text_format":"1","workbook":"xlsx","n_sheets":8,"sheets":["EnableMacros","Benefits Package 1","Cost Share Variances 1","DefaultBP","DefaultCSV","Names","Benefits Package 2","Cost Share Variances 2"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":45,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"EnableMacros","index":0,"n_rows":17,"n_cols":2,"rows_kept":17,"cut":false,"hidden":true,"merged":[[0,0,0,15],[1,0,1,15],[2,0,2,15]]}
["Plans & Benefits Template"]
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[null,"If you are seeing this sheet, macros are not enabled, please follow the following steps: "]
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[null,"If using Excel 2007 and 2010:"]
[null,"1. Set the macro security setting to Disable macros with notifications (Recommended) or Enable all macros. To change"]
[null,"    the macro security setting, click the Office Button and select Excel Option -> Trust Center -> Trust Center Settings -> "]
[null,"    Macro Settings."]
[null,"2. If the macro security setting is set to Disable macros with notifications, click the Option button and select Enable this "]
[null,"    content."]
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[null,"Note: This screen will flash momentarily when you save or finalize this workbook."]

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["2024 Plans & Benefits Template v13.0 [assistive technology users, please reference cell C1 for instructions]",null,"Press TAB and directional arrow keys to read through the document. If macros are disabled, press and hold the ALT key and press the F, then I, and then N keys. After that, select the Enable All Content option by pressing enter. Note that you can press the C key to select \"Enable All Content\". Template instructions can be found in cells D1 through D5.","To use this template, please review the user guide and instructions. All fields with an asterisk (*) are required"]
["HIOS Issuer ID*","41304",null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY24.xlam) on your machine."]
["Issuer State*","MA",null,"To create the cost share variance worksheet and enter the cost sharing amounts for both individual and SHOP (small group) markets, use the Create Cost Share Variances macro."]
["Market Coverage*","SHOP (Small Group)",null,"To create additional Benefits Package worksheets, use the Create New Benefits Package macro."]
["Dental Only Plan*","No",null,"To populate the benefits on the Benefits Package worksheet with your State EHB Standards, use the Refresh EHB macro."]
["Plan Identifiers",null,null,null,null,null,"Plan Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stand Alone Dental Only",null,"Plan Dates",null,"Geographic Coverage"]
["HIOS Plan ID*\n(Standard Component)","Plan Marketing Name*","HIOS Product ID*","Network ID*","Service Area ID*","Formulary ID*","New/Existing Plan?*","Plan Type*","Level of Coverage*","Design Type*","Unique Plan Design?*","QHP/Non-QHP*","Notice Required for Pregnancy*","Plan Level Exclusions","Limited Cost Sharing Plan Variation - Est Advanced Payment","Does this plan offer Composite Rating?*","Child-Only Offering*","Child Only Plan ID","Tobacco Wellness Program Offered*","Disease Management Programs Offered","EHB Percent of Total Premium*","EHB Apportionment for Pediatric Dental ","Guaranteed Rate ","Plan Effective Date*","Plan Expiration Date","Out of Country Coverage*","Out of Country Coverage Description","Out of Service Area Coverage*","Out of Service Area Coverage Description","National Network*"]
["41304MA0042039","Complete HMO 20/40","41304MA004","MAN001","MAS001","MAF001","Existing","HMO","Platinum","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042041","Complete HMO 30/55","41304MA004","MAN001","MAS001","MAF002","Existing","HMO","Gold","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042043","Complete HMO 1000 35%","41304MA004","MAN001","MAS001","MAF003","Existing","HMO","Gold","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042049","Complete HMO 2850","41304MA004","MAN001","MAS001","MAF005","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042045","Complete HMO 2000 25/60","41304MA004","MAN001","MAS001","MAF004","Existing","HMO","Silver","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042047","Complete HMO HSA 2000 30/60 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF006","Existing","HMO","Silver","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0072051","Complete PPO Plus 2000 25/60","41304MA007","MAN002","MAS001","MAF004","Existing","PPO","Silver","Not Applicable","Yes","Both","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0152053","Select HMO 2000 25/60 II","41304MA015","MAN003","MAS002","MAF004","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042055","Complete HMO 2000 25/60 II","41304MA004","MAN001","MAS001","MAF004","New","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0152059","Select HMO 30/55","41304MA015","MAN003","MAS002","MAF002","New","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042087","Complete HMO HSA 2500 30/45/450 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF016","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042155","Complete HMO HSA-E 3000 ER 350 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF017","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042089","Complete HMO HSA-E 3000 35/50/450 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF016","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042091","Complete HMO HSA-E 3600 35/50/600 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF018","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042161","Complete HMO HSA-E 3850 Enhanced FlexRx","41304MA004","MAN001","MAS001","MAF024","New","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0072115","Complete PPO Plus HSA 2500 30/45/450 Enhanced FlexRx","41304MA007","MAN002","MAS001","MAF016","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072117","Complete PPO Plus HSA-E 3000 35/50/450 Enhanced FlexRx","41304MA007","MAN002","MAS001","MAF016","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072119","Complete PPO Plus HSA-E 3600 35/50/600 Enhanced FlexRx","41304MA007","MAN002","MAS001","MAF018","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072165","Complete PPO Plus HSA-E 3850 Enhanced FlexRx","41304MA007","MAN002","MAS001","MAF024","New","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
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["Benefit Information",null,null,"General Information",null,null,null,null,null,null,"Out of Pocket Exceptions"]
["Benefits",null,"EHB","Is this Benefit Covered?","Quantitative Limit on Service","Limit Quantity","Limit Unit","Exclusions","Benefit Explanation","EHB Variance Reason","Excluded from In Network MOOP","Excluded from Out of Network MOOP"]
["Primary Care Visit to Treat an Injury or Illness",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Specialist Visit",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Hospice Services",null,"Yes","Covered","No",null,null,null,"Hospice services' means pain control and symptom relief and supportive and other care for a member who is terminally ill (the patient is expected to live six months or less).",null,"No","No"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,"Yes","Covered","No",null,null,null,"Only covers services to diagnose and treat infertility if unable to conceive after one year, or the member is age 35 or older and has not been able to conceive for 6 months; cryopreservation is covered if the member will undergo medical treatment which results in infertility. ",null,"No","No"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Covered","Yes","1","Exam(s) per Benefit Period",null,null,"Not EHB","No","No"]
["Urgent Care Centers or Facilities",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Home Health Care Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Emergency Room Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Emergency Transportation/Ambulance",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered","No",null,null,null,"In a Rehabilitation Hospital (60-day benefit limit per member per benefit period).",null,"No","No"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Bariatric Surgery",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Cosmetic Surgery",null,null,"Not Covered"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes","100","Days per Benefit Period",null,"Benefit limit per member.","Substantially Equal","No","No"]
["Prenatal and Postnatal Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Generic Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Preferred Brand Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Non-Preferred Brand Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Specialty Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"60 combined visit limit for physical therapy/occupational therapy per benefit period, but no benefit limit for speech therapy or when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health plan of care. ","Substantially Equal","No","No"]
["Habilitation Services",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"60 combined visit limit for physical therapy/occupational therapy per benefit period, but no benefit limit for speech therapy or when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health plan of care. ","Substantially Equal","No","No"]
["Chiropractic Care",null,"Yes","Covered","No",null,null,null,"This health plan covers outpatient chiropractic services when they are furnished for you by a chiropractor who is licensed to furnish the specific covered service.",null,"No","No"]
["Durable Medical Equipment",null,"Yes","Covered","No",null,null,null,"One electric breast pump per birth (rented or purchased).","Substantially Equal","No","No"]
["Hearing Aids",null,"Yes","Covered","Yes","2000","Dollars per 3 Years",null,"$2,000 for one hearing aid for each hearing impaired ear every 36 months for members 21 years or younger.",null,"No","No"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered","Yes","1","Exam(s) per Benefit Period",null,"GYN exam limited to one exam per benefit period.","Substantially Equal","No","No"]
["Routine Foot Care",null,null,"Covered","No",null,null,null,"Covered for Diabetes and some circulatory diseases.","Not EHB","No","No"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes","6","Months per Year",null,"Coverage for six months of membership fees in a qualified weight-loss program for either a covered Subscriber or one covered Dependent (see MassGeneralBrighamHealthPlan.org for qualifications).","Substantially Equal","No","No"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes","1","Exam(s) per Benefit Period",null,"1 exam(s) per benefit period with no cost-sharing.","Substantially Equal","No","No"]
["Eye Glasses for Children",null,"Yes","Covered","Yes","1","Item(s) per Benefit Period",null,"1 pair eyeglasses per benefit period with no cost-sharing for a 'Collection Frame'. Contact lenses once per year in lieu of eyeglasses. ","Substantially Equal","No","No"]
["Dental Check-Up for Children",null,"Yes","Covered","Yes","2","Exam(s) per Benefit Period",null,"See Schedule of Benefits for more detail.","Substantially Equal","No","No"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"60 visits combined outpatient physical and occupational therapy.","Substantially Equal","No","No"]
["Well Baby Visits and Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Basic Dental Care – Child",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Orthodontia – Child",null,null,"Covered","No",null,null,null,"Medically necessary orthodontia covered.","Additional EHB Benefit","No","No"]
["Major Dental Care – Child",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Basic Dental Care – Adult",null,null,"Not Covered"]
["Orthodontia – Adult",null,null,"Not Covered"]
["Major Dental Care – Adult",null,null,"Not Covered"]
["Abortion for Which Public Funding is Prohibited",null,null,"Covered","No",null,null,null,null,"Not EHB","No","No"]
["Transplant",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Accidental Dental",null,null,"Covered","No",null,null,null,"Covered when provided in an emergency room within 72 hours of an accident or injury.","Not EHB","No","No"]
["Dialysis",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Allergy Testing",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Chemotherapy",null,"Yes","Covered","No",null,null,null,"Coverage includes orally administered anticancer medication used to eliminate or slow the growth of cancerous cells.","Substantially Equal","No","No"]
["Radiation",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Diabetes Education",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Prosthetic Devices",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Infusion Therapy",null,"Yes","Covered","No",null,null,null,"Home infusion therapy that is furnished for you by a home infusion therapy provider. This includes: the infusion solution; the preparation of the solution; the equipment for its administration; and necessary part-time nursing.",null,"No","No"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Nutritional Counseling",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Reconstructive Surgery",null,"Yes","Covered","No",null,null,null,"This means non-dental surgery that is meant to improve or give you back bodily function or to correct a functional physical impairment that was caused by: a birth defect; developmental abnormality; a prior surgical procedure or disease; or an accidental injury. It also includes surgery that is done to correct a deformity or disfigurement that was caused by an accidental injury.","Substantially Equal","No","No"]
["Gender Affirming Care",null,null,"Covered","No",null,null,null,"Your plan covers gender affirming procedures for individuals when it is recommended by the member’s providers and when medically necessary.  Covered services include, but are not limited to, Facial Feminization/Masculinization, breast reconstruction surgery/mastectomy, and cryopreservation of eggs/embryos, and sperm. Member cost is based on type of service and treating provider. For a more complete list of Covered services, please refer to the Gender Affirming medical policy at Member.MassGeneralBrighamHealthPlan.org.\n\n","Not EHB","No","No"]

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["All fields with an asterisk (*) are required",null,null,null,null,null,null,null,null,null,null,null,null,"SBC Scenario",null,null,null,null,null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Drug EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical and Drug EHB Benefits (Total)",null,null,null,null,null,null,null,"Medical EHB Deductible",null,null,null,null,null,null,null,null,null,"Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"Combined Medical and Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"HSA/HRA Detail",null,null,"AV Calculator Additional Benefit Design",null,null,null,null,null,null,"custom 1",null,null,null,null,null,null,null,"custom 2",null,null,null,null,null,null,null,"custom 3",null,null,null,null,null,null,null,"Primary Care Visit to Treat an Injury or Illness",null,null,null,null,null,"Specialist Visit",null,null,null,null,null,"Other Practitioner Office Visit (Nurse, Physician Assistant)",null,null,null,null,null,"Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,null,null,null,null,"Outpatient Surgery Physician/Surgical Services",null,null,null,null,null,"Hospice Services",null,null,null,null,null,"Infertility Treatment",null,null,null,null,null,"Routine Eye Exam (Adult)",null,null,null,null,null,"Urgent Care Centers or Facilities",null,null,null,null,null,"Home Health Care Services",null,null,null,null,null,"Emergency Room Services",null,null,null,null,null,"Emergency Transportation/Ambulance",null,null,null,null,null,"Inpatient Hospital Services (e.g., Hospital Stay)",null,null,null,null,null,"Inpatient Physician and Surgical Services",null,null,null,null,null,"Bariatric Surgery",null,null,null,null,null,"Skilled Nursing Facility",null,null,null,null,null,"Prenatal and Postnatal Care",null,null,null,null,null,"Delivery and All Inpatient Services for Maternity Care",null,null,null,null,null,"Mental/Behavioral Health Outpatient Services",null,null,null,null,null,"Mental/Behavioral Health Inpatient Services",null,null,null,null,null,"Substance Abuse Disorder Outpatient Services",null,null,null,null,null,"Substance Abuse Disorder Inpatient Services",null,null,null,null,null,"Generic Drugs",null,null,null,null,null,"Preferred Brand Drugs",null,null,null,null,null,"Non-Preferred Brand Drugs",null,null,null,null,null,"Specialty Drugs",null,null,null,null,null,"Outpatient Rehabilitation Services",null,null,null,null,null,"Habilitation Services",null,null,null,null,null,"Chiropractic Care",null,null,null,null,null,"Durable Medical Equipment",null,null,null,null,null,"Hearing Aids",null,null,null,null,null,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",null,null,null,null,null,"Routine Foot Care",null,null,null,null,null,"Weight Loss Programs",null,null,null,null,null,"Routine Eye Exam for Children",null,null,null,null,null,"Eye Glasses for Children",null,null,null,null,null,"Dental Check-Up for Children",null,null,null,null,null,"Rehabilitative Speech Therapy",null,null,null,null,null,"Rehabilitative Occupational and Rehabilitative Physical Therapy",null,null,null,null,null,"Well Baby Visits and Care",null,null,null,null,null,"Laboratory Outpatient and Professional Services",null,null,null,null,null,"X-rays and Diagnostic Imaging",null,null,null,null,null,"Basic Dental Care – Child",null,null,null,null,null,"Orthodontia – Child",null,null,null,null,null,"Major Dental Care – Child",null,null,null,null,null,"Abortion for Which Public Funding is Prohibited",null,null,null,null,null,"Transplant",null,null,null,null,null,"Accidental Dental",null,null,null,null,null,"Dialysis",null,null,null,null,null,"Allergy Testing",null,null,null,null,null,"Chemotherapy",null,null,null,null,null,"Radiation",null,null,null,null,null,"Diabetes Education",null,null,null,null,null,"Prosthetic Devices",null,null,null,null,null,"Infusion Therapy",null,null,null,null,null,"Treatment for Temporomandibular Joint Disorders",null,null,null,null,null,"Nutritional Counseling",null,null,null,null,null,"Reconstructive Surgery",null,null,null,null,null,"Gender Affirming Care"]
["Plan Cost Sharing Attributes",null,null,null,null,null,null,null,null,null,null,null,null,"Having a Baby",null,null,null,"Having Diabetes",null,null,null,"Treatment of a Simple Fracture",null,null,null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,null,null,null,null,null,null,null,null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance"]
["HIOS Plan ID \n(Standard Component + Variant)","Plan Variant Marketing Name*","Level of Coverage\n(Metal Level)","CSR Variation Type","Issuer Actuarial Value","AV Calculator Output Number*","Medical & Drug Deductibles Integrated?*","Medical & Drug Maximum Out of Pocket Integrated?*","Is a Referral Required for Specialist?*","Specialist(s) Requiring a Referral","Multiple In Network Tiers?*","1st Tier Utilization*","2nd Tier Utilization","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","HSA Eligible*","HSA/HRA Employer Contribution","HSA/HRA Employer Contribution Amount","Maximum Coinsurance for Specialty Drugs","Maximum Number of Days for Charging an Inpatient Copay?","Begin Primary Care Cost-Sharing After a Set Number of Visits?","Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays?","Blank","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network"]
["41304MA0042039-00","Complete HMO 20/40","Platinum","Standard Platinum Off Exchange Plan",0.90349999999999997,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,600,0,0,0,500,0,0,0,400,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,40,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,10,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,150,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1]
["41304MA0042039-01","Standard Platinum: Complete HMO 20/40","Platinum","Standard Platinum On Exchange Plan",0.90349999999999997,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,600,0,0,0,500,0,0,0,400,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,40,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,10,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,150,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1]
["41304MA0042041-00","Complete HMO 30/55","Gold","Standard Gold Off Exchange Plan",0.81620000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,1100,0,0,0,1000,0,0,0,700,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,6000,"$6000 per person | $12000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1]
["41304MA0042041-01","Standard High Gold: Complete HMO 30/55","Gold","Standard Gold On Exchange Plan",0.81620000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,1100,0,0,0,1000,0,0,0,700,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,6000,"$6000 per person | $12000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1]
["41304MA0042043-00","Complete HMO 1000 35%","Gold","Standard Gold Off Exchange Plan",0.78080000000000005,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,1000,300,2500,0,100,700,0,0,1000,300,400,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7900,"$7900 per person | $15800 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1000,"$1000 per person | $2000 per group",0.35,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,45,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,20,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1]
["41304MA0042043-01","Non-Standard Low Gold: Complete HMO 1000 35%","Gold","Standard Gold On Exchange Plan",0.78080000000000005,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,1000,300,2500,0,100,700,0,0,1000,300,400,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7900,"$7900 per person | $15800 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1000,"$1000 per person | $2000 per group",0.35,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,45,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,20,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1]
["41304MA0042045-00","Complete HMO 2000 25/60","Silver","Standard Silver Off Exchange Plan",0.71819999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042045-01","Standard Silver: Complete HMO 2000 25/60","Silver","Standard Silver On Exchange Plan",0.71819999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042047-00","Complete HMO HSA 2000 30/60 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.71660000000000001,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,2000,500,0,0,2000,400,9,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7050,"$7050 per person | $14100 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$4000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"$60.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"$300.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$105.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$105.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"$300.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042047-01","Standard Low Silver: Complete HMO HSA 2000 30/60 Enhanced FlexRx","Silver","Standard Silver On Exchange Plan",0.71660000000000001,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,2000,500,0,0,2000,400,9,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7050,"$7050 per person | $14100 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$4000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"$60.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"$300.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$105.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$105.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"$300.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042049-00","Complete HMO 2850","Expanded Bronze","Standard Bronze Off Exchange Plan",0.64739999999999998,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2850,1100,0,0,1300,500,0,0,2800,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2850,"$2850 per person | $5700 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"$65.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042049-01","Standard High Bronze: Complete HMO 2850","Expanded Bronze","Standard Bronze On Exchange Plan",0.64739999999999998,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2850,1100,0,0,1300,500,0,0,2800,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2850,"$2850 per person | $5700 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"$65.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$65.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042055-00","Complete HMO 2000 25/60 II","Silver","Standard Silver Off Exchange Plan",0.71819999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable",5,null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,5,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042087-00","Complete HMO HSA 2500 30/45/450 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.70950000000000002,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2500,800,0,0,2500,400,0,0,2500,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$5000 per person | $5000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"$45.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$200.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042089-00","Complete HMO HSA-E 3000 35/50/450 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.6976,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3000,800,0,0,3000,300,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"$50.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$200.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042091-00","Complete HMO HSA-E 3600 35/50/600 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.68330000000000002,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3600,1200,0,0,3600,200,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3600,"$3600 per person | $7200 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"$50.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$600.00 Copay after deductible",null,"$600.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$600.00 Copay after deductible",null,"$600.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042155-00","Complete HMO HSA-E 3000 ER 350 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.71330000000000005,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3000,700,0,0,3000,200,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$200.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042161-00","Complete HMO HSA-E 3850 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.68130000000000002,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3850,100,2100,0,3850,100,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8000,"$8000 per person | $16000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3850,"$3850 per person | $7700 per group",0.3,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"$55.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1]
["41304MA0072051-00","Complete PPO Plus 2000 25/60","Silver","Standard Silver Off Exchange Plan",0.71819999999999995,null,"Yes","Yes","No",null,"No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,4000,"$4000 per person | $8000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072051-01","Standard High Sliver: Complete PPO Plus 2000 25/60","Silver","Standard Silver On Exchange Plan",0.71819999999999995,null,"Yes","Yes","No",null,"No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,4000,"$4000 per person | $8000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072115-00","Complete PPO Plus HSA 2500 30/45/450 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.70950000000000002,null,"Yes","Yes","No",null,"No",1,null,2500,800,0,0,2500,400,0,0,2500,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,15000,"$15000 per person | $30000 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$5000 per person | $5000 per group",0.2,null,null,null,5000,"$10000 per person | $10000 per group","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$200.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072117-00","Complete PPO Plus HSA-E 3000 35/50/450 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.6976,null,"Yes","Yes","No",null,"No",1,null,3000,800,0,0,3000,300,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,15000,"$15000 per person | $30000 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,null,null,null,6000,"$6000 per person | $12000 per group","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$200.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$450.00 Copay after deductible",null,"$450.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072119-00","Complete PPO Plus HSA-E 3600 35/50/600 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.68330000000000002,null,"Yes","Yes","No",null,"No",1,null,3600,1200,0,0,3600,200,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7500,"$7500 per person | $15000 per group",null,null,15000,"$15000 per person | $30000 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3600,"$3600 per person | $7200 per group",0.2,null,null,null,7200,"$7200 per person | $14400 per group","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$600.00 Copay after deductible",null,"$600.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$600.00 Copay after deductible",null,"$600.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072165-00","Complete PPO Plus HSA-E 3850 Enhanced FlexRx","Silver","Standard Silver Off Exchange Plan",0.68130000000000002,null,"Yes","Yes","No",null,"No",1,null,3850,100,2100,0,3850,100,0,0,2800,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8000,"$8000 per person | $16000 per group",null,null,16000,"$16000 per person | $32000 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3850,"$3850 per person | $7700 per group",0.3,null,null,null,7700,"$7700 per person | $15400 per group","Not Applicable","per person not applicable | per group not applicable","Yes","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","$30.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible"]
["41304MA0152053-00","Select HMO 2000 25/60 II","Silver","Standard Silver Off Exchange Plan",0.71819999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,100,900,0,0,2000,400,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable",5,null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,5,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0152059-00","Select HMO 30/55","Gold","Standard Gold Off Exchange Plan",0.81620000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,1100,0,0,0,1000,0,0,0,700,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,6000,"$6000 per person | $12000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,90,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1,750,null,"Not Applicable","Not Applicable",null,1]

{"sheet":"DefaultBP","index":3,"n_rows":127,"n_cols":30,"rows_kept":127,"cut":false,"hidden":true,"merged":[[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[120,0,120,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[113,0,113,1],[114,0,114,1],[115,0,115,1],[116,0,116,1],[117,0,117,1],[118,0,118,1],[119,0,119,1],[108,0,108,1],[97,0,97,1],[98,0,98,1],[99,0,99,1],[100,0,100,1],[101,0,101,1],[102,0,102,1],[103,0,103,1],[104,0,104,1],[105,0,105,1],[106,0,106,1],[107,0,107,1],[96,0,96,1],[85,0,85,1],[86,0,86,1],[87,0,87,1],[88,0,88,1],[89,0,89,1],[90,0,90,1],[91,0,91,1],[92,0,92,1],[93,0,93,1],[94,0,94,1],[95,0,95,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[84,0,84,1],[73,0,73,1],[74,0,74,1],[75,0,75,1],[76,0,76,1],[77,0,77,1],[78,0,78,1],[79,0,79,1],[80,0,80,1],[81,0,81,1],[82,0,82,1],[83,0,83,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[126,0,126,1],[5,23,5,24],[5,25,5,29],[57,10,57,11],[58,0,58,1],[59,0,59,1],[5,0,5,5],[60,0,60,1],[5,6,5,20],[5,21,5,22],[57,0,57,2],[57,3,57,9],[72,0,72,1],[61,0,61,1],[62,0,62,1],[63,0,63,1]]}
["2024 Plans & Benefits Template v13.0 [assistive technology users, please reference cell C1 for instructions]",null,"Press TAB and directional arrow keys to read through the document. If macros are disabled, press and hold the ALT key and press the F, then I, and then N keys. After that, select the Enable All Content option by pressing enter. Note that you can press the C key to select \"Enable All Content\". Template instructions can be found in cells D1 through D5.","To use this template, please review the user guide and instructions. All fields with an asterisk (*) are required"]
["HIOS Issuer ID*",null,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY24.xlam) on your machine."]
["Issuer State*",null,null,"To create the cost share variance worksheet and enter the cost sharing amounts for both individual and SHOP (small group) markets, use the Create Cost Share Variances macro."]
["Market Coverage*",null,null,"To create additional Benefits Package worksheets, use the Create New Benefits Package macro."]
["Dental Only Plan*",null,null,"To populate the benefits on the Benefits Package worksheet with your State EHB Standards, use the Refresh EHB macro."]
["Plan Identifiers",null,null,null,null,null,"Plan Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stand Alone Dental Only",null,"Plan Dates",null,"Geographic Coverage"]
["HIOS Plan ID*\n(Standard Component)","Plan Marketing Name*","HIOS Product ID*","Network ID*","Service Area ID*","Formulary ID*","New/Existing Plan?*","Plan Type*","Level of Coverage*","Design Type*","Unique Plan Design?*","QHP/Non-QHP*","Notice Required for Pregnancy*","Plan Level Exclusions","Limited Cost Sharing Plan Variation - Est Advanced Payment","Does this plan offer Composite Rating?*","Child-Only Offering*","Child Only Plan ID","Tobacco Wellness Program Offered*","Disease Management Programs Offered","EHB Percent of Total Premium*","EHB Apportionment for Pediatric Dental ","Guaranteed Rate ","Plan Effective Date*","Plan Expiration Date","Out of Country Coverage*","Out of Country Coverage Description","Out of Service Area Coverage*","Out of Service Area Coverage Description","National Network*"]
[]
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["Benefit Information",null,null,"General Information",null,null,null,null,null,null,"Out of Pocket Exceptions"]
["Benefits",null,"EHB","Is this Benefit Covered?","Quantitative Limit on Service","Limit Quantity","Limit Unit","Exclusions","Benefit Explanation","EHB Variance Reason","Excluded from In Network MOOP","Excluded from Out of Network MOOP"]
["Primary Care Visit to Treat an Injury or Illness"]
["Specialist Visit"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)"]
["Outpatient Surgery Physician/Surgical Services"]
["Hospice Services"]
["Routine Dental Services (Adult)"]
["Infertility Treatment"]
["Long-Term/Custodial Nursing Home Care"]
["Private-Duty Nursing"]
["Routine Eye Exam (Adult)"]
["Urgent Care Centers or Facilities"]
["Home Health Care Services"]
["Emergency Room Services"]
["Emergency Transportation/Ambulance"]
["Inpatient Hospital Services (e.g., Hospital Stay)"]
["Inpatient Physician and Surgical Services"]
["Bariatric Surgery"]
["Cosmetic Surgery"]
["Skilled Nursing Facility"]
["Prenatal and Postnatal Care"]
["Delivery and All Inpatient Services for Maternity Care"]
["Mental/Behavioral Health Outpatient Services"]
["Mental/Behavioral Health Inpatient Services"]
["Substance Abuse Disorder Outpatient Services"]
["Substance Abuse Disorder Inpatient Services"]
["Generic Drugs"]
["Preferred Brand Drugs"]
["Non-Preferred Brand Drugs"]
["Specialty Drugs"]
["Outpatient Rehabilitation Services"]
["Habilitation Services"]
["Chiropractic Care"]
["Durable Medical Equipment"]
["Hearing Aids"]
["Imaging (CT/PET Scans, MRIs)"]
["Preventive Care/Screening/Immunization"]
["Routine Foot Care"]
["Acupuncture"]
["Weight Loss Programs"]
["Routine Eye Exam for Children"]
["Eye Glasses for Children"]
["Dental Check-Up for Children"]
["Rehabilitative Speech Therapy"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy"]
["Well Baby Visits and Care"]
["Laboratory Outpatient and Professional Services"]
["X-rays and Diagnostic Imaging"]
["Basic Dental Care – Child"]
["Orthodontia – Child"]
["Major Dental Care – Child"]
["Basic Dental Care – Adult"]
["Orthodontia – Adult"]
["Major Dental Care – Adult"]
["Abortion for Which Public Funding is Prohibited"]
["Transplant"]
["Accidental Dental"]
["Dialysis"]
["Allergy Testing"]
["Chemotherapy"]
["Radiation"]
["Diabetes Education"]
["Prosthetic Devices"]
["Infusion Therapy"]
["Treatment for Temporomandibular Joint Disorders"]
["Nutritional Counseling"]
["Reconstructive Surgery"]
["Gender Affirming Care"]

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["All fields with an asterisk (*) are required",null,null,null,null,null,null,null,null,null,null,null,null,"SBC Scenario",null,null,null,null,null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Drug EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical and Drug EHB Benefits (Total)",null,null,null,null,null,null,null,"Medical EHB Deductible",null,null,null,null,null,null,null,null,null,"Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"Combined Medical and Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"HSA/HRA Detail",null,null,"AV Calculator Additional Benefit Design",null,null,null,null,null,null,"custom 1",null,null,null,null,null,null,null,"custom 2",null,null,null,null,null,null,null,"custom 3"]
["Plan Cost Sharing Attributes",null,null,null,null,null,null,null,null,null,null,null,null,"Having a Baby",null,null,null,"Having Diabetes",null,null,null,"Treatment of a Simple Fracture",null,null,null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,null,null,null,null,null,null,null,null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance"]
["HIOS Plan ID\n(Standard Component + Variant)","Plan Variant Marketing Name*","Level of Coverage\n(Metal Level)","CSR Variation Type","Issuer Actuarial Value","AV Calculator Output Number*","Medical & Drug Deductibles Integrated?*","Medical & Drug Maximum Out of Pocket Integrated?*","Is a Referral Required for Specialist?*","Specialist(s) Requiring a Referral","Multiple In Network Tiers?*","1st Tier Utilization*","2nd Tier Utilization","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","HSA Eligible*","HSA/HRA Employer Contribution","HSA/HRA Employer Contribution Amount","Maximum Coinsurance for Specialty Drugs","Maximum Number of Days for Charging an Inpatient Copay?","Begin Primary Care Cost-Sharing After a Set Number of Visits?","Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays?","Blank","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network 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{"sheet":"Names","index":5,"n_rows":141,"n_cols":9,"rows_kept":141,"cut":false,"hidden":true,"merged":[]}
["Individual","AK","Yes","Accidental Ingestion of a Controlled Drug",null,"CSV Code Name","Already Ran AVC","Data Modified After Running AVC","Modified Fields"]
["SHOP (Small Group)","AL",null,"Anesthetics",null,"Sheet3",false,false]
[null,"AR",null,"Applied Behavior Analysis Based Therapies"]
["Bronze","AZ",null,"Attention Deficit Disorder"]
["Expanded Bronze","CA",null,"Autism Spectrum Disorders"]
["Silver","CO",null,"Blood and Blood Services"]
["Gold","CT",null,"Bone Marrow Testing"]
["Platinum","DC",null,"Bone Marrow Transplant"]
["Catastrophic","DE",null,"Bone Marrow Transplants for Treatment of Breast Cancer"]
[null,"FL",null,"Bones/Joints"]
["Yes","GA",null,"Brain Injury"]
["No","HI",null,"Breast Implant Removal"]
[null,"IA",null,"Breast Reconstructive Surgery"]
["Indemnity","ID",null,"Cancer Treatments"]
["PPO","IL",null,"Cardiac Rehabilitation"]
["HMO","IN",null,"Clinical Trials"]
["POS","KS",null,"Cochlear Implants"]
["EPO","KY",null,"Congenital Anomaly, including Cleft Lip/Palate"]
[null,"LA",null,"Contraceptive Services"]
["Allows Adult and Child-Only","MA",null,"Coverage for Effects of Diethylstilbestrol"]
["Allows Adult-Only","MD",null,"Dental Anesthesia"]
["Allows Child-Only","ME",null,"Developmental Needs of Children & Youth with Cancer"]
[null,"MI",null,"Diabetes Care Management"]
["New","MN",null,"Domestic Violence Treatment"]
["Existing","MO",null,"Drug Infusion Administration"]
[null,"MS",null,"Early Intervention Services"]
["Yes","MT",null,"Eating Disorder Treatment"]
["No","NC",null,"Emegency Transportation/Ambulance"]
["Not Applicable","ND",null,"Experimental or Investigational Services"]
[null,"NE",null,"Family Therapy"]
[null,"NH",null,"Gastric Electrical Stimulation"]
["$X","NJ",null,"Heart Transplant"]
["Not Applicable","NM",null,"Hormone Replacement Therapy (HRT)"]
[null,"NV",null,"Human Leukocyte Antigen Testing"]
["On the Exchange","NY",null,"Hypodermic Syringes or Needles "]
["Off the Exchange","OH",null,"Infant Formulas"]
["Both","OK",null,"Inherited Metabolic Disorder - PKU"]
[null,"OR",null,"Mental Health Other"]
["Covered","PA",null,"Mental Health Parity"]
["Not Covered","RI",null,"Morbid Obesity Treatment"]
[null,"SC",null,"Multiple Sclerosis "]
["Standard Plan","SD",null,"Network Retail Pharmacy (60-90 Day Supply) Covered"]
["73% AV CSR Silver Plan Variation","TN",null,"Newborn Hearing Screening"]
["87% AV CSR Silver Plan Variation","TX",null,"Newborn Services Other"]
["94% AV CSR Silver Plan Variation","UT",null,"Nutrition/Formulas"]
["Zero Cost Sharing Plan Variation","VA",null,"Off Label Prescription Drugs"]
["Limited Cost Sharing Plan Variation","VT",null,"Oral Surgery"]
[null,"WA",null,"Organ Transplants"]
["Click here to select","WI",null,"Osteoporosis"]
[null,"WV",null,"Outpatient Contraceptive Services Including Sterilizations"]
["Not EHB","WY",null,"Oxygen"]
["Substituted",null,null,"Pediatric Services Other"]
["Substantially Equal",null,null,"Port-Wine Stain Removal"]
["Using Alternate Benchmark",null,null,"Post-Mastectomy Care"]
["Other Law/Regulation",null,null,"Prescription Drugs Other"]
["Additional EHB Benefit",null,null,"Prescription Drugs Other "]
["Dental Only Plan Available",null,null,"Rape and Incest Coverage"]
[null,null,null,"Rehabilitative Occupational Therapy"]
["No Charge",null,null,"Rehabilitative Physical Therapy"]
["No Charge after deductible",null,null,"Residential Treatment for Children with Emotional Disabilities"]
["$X",null,null,"Second Opinion"]
["$X Copay after deductible",null,null,"Second Opinions Related to Chemical Dependency and Mental Health"]
["$X Copay with deductible",null,null,"Second Surgical Opinion"]
["Not Applicable",null,null,"Services to Ventilator-Dependent Persons"]
[null,null,null,"Sickle Cell Anemia"]
["$X Copay per Stay",null,null,"Third Opinion"]
["$X Copay per Stay with deductible",null,null,"Transplant Donor Coverage"]
["$X Copay per Stay after deductible",null,null,"Transplant Surgery—Donor Charges"]
["$X Copay per Day",null,null,"Treatment of hemophilia"]
["$X Copay per Day with deductible",null,null,"Treatment of Lyme Disease"]
["$X Copay per Day after deductible",null,null,"Treatment of Medical Complications of Alcoholism"]
["No Charge",null,null,"Well Child Care"]
["No Charge after deductible",null,null,"Wigs"]
["Not Applicable",null,null,"Wilm's Tumor"]
[null,null,null,"Wound Care for Individuals with Epidermolysis Bullosa"]
["No Charge"]
["No Charge after deductible",null,null,"Abortion for Which Public Funding is Prohibited"]
["X%",null,null,"Acupuncture"]
["X% Coinsurance after deductible",null,null,"Allergy Testing"]
["Not Applicable",null,null,"Bariatric Surgery"]
[null,null,null,"Chemotherapy"]
["Asthma",null,null,"Chiropractic Care"]
["Heart Disease",null,null,"Cosmetic Surgery"]
["Depression",null,null,"Delivery and All Inpatient Services for Maternity Care"]
["Diabetes",null,null,"Diabetes Education"]
["High Blood Pressure & High Cholesterol",null,null,"Dialysis"]
["Low Back Pain",null,null,"Durable Medical Equipment"]
["Pain Management",null,null,"Emergency Room Services"]
["Pregnancy",null,null,"Emergency Transportation/Ambulance"]
["Weight Loss Programs",null,null,"Eye Glasses for Children"]
[null,null,null,"Habilitation Services"]
["Visit(s)",null,null,"Hearing Aids"]
["Dollars",null,null,"Home Health Care Services"]
["Exam(s)",null,null,"Hospice Services"]
["Days",null,null,"Imaging (CT/PET Scans, MRIs)"]
["Item(s)",null,null,"Infertility Treatment"]
["Months",null,null,"Infusion Therapy"]
["Treatment(s)",null,null,"Inpatient Hospital Services (e.g., Hospital Stay)"]
["Procedure(s)",null,null,"Inpatient Physician and Surgical Services"]
["Hours",null,null,"Laboratory Outpatient and Professional Services"]
["Admission(s)",null,null,"Long-Term/Custodial Nursing Home Care"]
[null,null,null,"Mental/Behavioral Health Inpatient Services"]
["Year",null,null,"Mental/Behavioral Health Outpatient Services"]
["Benefit Period",null,null,"Non-Emergency Care When Traveling Outside the U.S."]
["Lifetime",null,null,"Nutritional Counseling"]
["Month",null,null,"Other Practitioner Office Visit (Nurse, Physician Assistant)"]
["Episode",null,null,"Outpatient Facility Fee (e.g., Ambulatory Surgery Center)"]
["Stay",null,null,"Outpatient Rehabilitation Services"]
["Transplant",null,null,"Outpatient Surgery Physician/Surgical Services"]
["6 Months",null,null,"Prenatal and Postnatal Care"]
["2 Years",null,null,"Preventive Care/Screening/Immunization"]
["3 Years",null,null,"Primary Care Visit to Treat an Injury or Illness"]
["Procedure",null,null,"Private-Duty Nursing"]
["Week",null,null,"Prosthetic Devices"]
["Admission",null,null,"Radiation"]
[null,null,null,"Reconstructive Surgery"]
["Guaranteed Rate ",null,null,"Rehabilitative Occupational and Rehabilitative Physical Therapy"]
[null,null,null,"Rehabilitative Speech Therapy"]
[null,null,null,"Routine Eye Exam (Adult)"]
["High",null,null,"Routine Eye Exam for Children"]
["Low",null,null,"Routine Foot Care"]
[null,null,null,"Skilled Nursing Facility"]
["$X Copay per Stay",null,null,"Specialist Visit"]
["$X Copay per Stay with deductible",null,null,"Substance Abuse Disorder Inpatient Services"]
["$X Copay per Stay after deductible",null,null,"Substance Abuse Disorder Outpatient Services"]
["$X Copay per Day",null,null,"Transplant"]
["$X Copay per Day with deductible",null,null,"Treatment for Temporomandibular Joint Disorders"]
["$X Copay per Day after deductible",null,null,"Urgent Care Centers or Facilities"]
["$X",null,null,"Weight Loss Programs"]
["$X Copay with deductible",null,null,"Well Baby Visits and Care"]
["$X Copay after deductible",null,null,"X-rays and Diagnostic Imaging"]
["No Charge"]
["No Charge after deductible",null,null,"Click to enter Family MOOP"]
["Not Applicable"]
[null,null,null,"Click to enter Family Deductible"]
["Not Applicable"]
["Design 1"]
["Design 2"]
["Design 3"]
["Design 4"]
["Design 5"]

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["2024 Plans & Benefits Template v13.0 [assistive technology users, please reference cell C1 for instructions]",null,"Press TAB and directional arrow keys to read through the document. If macros are disabled, press and hold the ALT key and press the F, then I, and then N keys. After that, select the Enable All Content option by pressing enter. Note that you can press the C key to select \"Enable All Content\". Template instructions can be found in cells D1 through D5.","To use this template, please review the user guide and instructions. All fields with an asterisk (*) are required"]
["HIOS Issuer ID*","41304",null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY24.xlam) on your machine."]
["Issuer State*","MA",null,"To create the cost share variance worksheet and enter the cost sharing amounts for both individual and SHOP (small group) markets, use the Create Cost Share Variances macro."]
["Market Coverage*","SHOP (Small Group)",null,"To create additional Benefits Package worksheets, use the Create New Benefits Package macro."]
["Dental Only Plan*","No",null,"To populate the benefits on the Benefits Package worksheet with your State EHB Standards, use the Refresh EHB macro."]
["Plan Identifiers",null,null,null,null,null,"Plan Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stand Alone Dental Only",null,"Plan Dates",null,"Geographic Coverage"]
["HIOS Plan ID*\n(Standard Component)","Plan Marketing Name*","HIOS Product ID*","Network ID*","Service Area ID*","Formulary ID*","New/Existing Plan?*","Plan Type*","Level of Coverage*","Design Type*","Unique Plan Design?*","QHP/Non-QHP*","Notice Required for Pregnancy*","Plan Level Exclusions","Limited Cost Sharing Plan Variation - Est Advanced Payment","Does this plan offer Composite Rating?*","Child-Only Offering*","Child Only Plan ID","Tobacco Wellness Program Offered*","Disease Management Programs Offered","EHB Percent of Total Premium*","EHB Apportionment for Pediatric Dental ","Guaranteed Rate ","Plan Effective Date*","Plan Expiration Date","Out of Country Coverage*","Out of Country Coverage Description","Out of Service Area Coverage*","Out of Service Area Coverage Description","National Network*"]
["41304MA0042063","Complete HMO 20/40 with Care Complement","41304MA004","MAN001","MAS001","MAF008","Existing","HMO","Platinum","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042065","Complete HMO 500 with Care Complement","41304MA004","MAN001","MAS001","MAF009","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042067","Complete HMO 1000 25/50/350 with Care Complement","41304MA004","MAN001","MAS001","MAF009","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042069","Complete HMO 1000 10%/30% with Care Complement","41304MA004","MAN001","MAS001","MAF010","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042071","Complete HMO 1500 25/50 ER350 with Care Complement","41304MA004","MAN001","MAS001","MAF021","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042073","Complete HMO 2000 20/40/400 with Care Complement","41304MA004","MAN001","MAS001","MAF021","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042157","Complete HMO 2000 25/60 with Care Complement","41304MA004","MAN001","MAS001","MAF004","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042075","Complete HMO 2000 30/60/1000 with Care Complement","41304MA004","MAN001","MAS001","MAF011","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042079","Complete HMO 2500 15%/35% with Care Complement","41304MA004","MAN001","MAS001","MAF012","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042077","Complete HMO 2500 30/55/500 with Care Complement","41304MA004","MAN001","MAS001","MAF013","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042081","Complete HMO 3000 40/55/500 with Care Complement ","41304MA004","MAN001","MAS001","MAF014","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042159","Complete HMO 3500 with Care Complement ","41304MA004","MAN001","MAS001","MAF025","New","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042083","Complete HMO 4000 35/45/750 10% with Care Complement","41304MA004","MAN001","MAS001","MAF011","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0042085","Complete HMO 5000 35/45/750 10% with Care Complement","41304MA004","MAN001","MAS001","MAF022","Existing","HMO","Expanded Bronze","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0072093","Complete PPO Plus 500 with Care Complement","41304MA007","MAN002","MAS001","MAF009","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072095","Complete PPO Plus 1000 25/50/350 with Care Complement","41304MA007","MAN002","MAS001","MAF009","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072097","Complete PPO Plus 1000 10%/30% with Care Complement","41304MA007","MAN002","MAS001","MAF010","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072099","Complete PPO Plus 1500 25/50 ER350 with Care Complement","41304MA007","MAN002","MAS001","MAF021","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072101","Complete PPO Plus 2000 20/40/400 with Care Complement","41304MA007","MAN002","MAS001","MAF021","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072103","Complete PPO Plus 2000 30/60/1000 with Care Complement","41304MA007","MAN002","MAS001","MAF011","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072107","Complete PPO Plus 2500 15%/35% with Care Complement","41304MA007","MAN002","MAS001","MAF012","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072105","Complete PPO Plus 2500 30/55/500 with Care Complement","41304MA007","MAN002","MAS001","MAF013","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2023",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072109","Complete PPO Plus 3000 40/55/500with Care Complement","41304MA007","MAN002","MAS001","MAF014","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072163","Complete PPO Plus 3500 with Care Complement","41304MA007","MAN002","MAS001","MAF025","New","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072111","Complete PPO Plus 4000 35/45/750 10% with Care Complement","41304MA007","MAN002","MAS001","MAF011","Existing","PPO","Expanded Bronze","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0072113","Complete PPO Plus 5000 35/45/750 10% with Care Complement","41304MA007","MAN002","MAS001","MAF022","Existing","PPO","Expanded Bronze","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0092121","Choice Easy Tier HMO 500 with Care Complement","41304MA009","MAN004","MAS001","MAF019","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092123","Choice Easy Tier HMO 1000 25/40/300 With Care Complement","41304MA009","MAN004","MAS001","MAF019","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092125","Choice Easy Tier HMO 1500 with Care Complement","41304MA009","MAN004","MAS001","MAF019","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092127","Choice Easy Tier HMO 2000 25/40 with Care Complement","41304MA009","MAN004","MAS001","MAF019","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092133","Choice Easy Tier HMO 2500 with Care Complement","41304MA009","MAN004","MAS001","MAF020","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092129","Choice Easy Tier HMO 2500 15%/35% with Care Complement","41304MA009","MAN004","MAS001","MAF023","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0092131","Choice Easy Tier HMO 3000 with Care Complement","41304MA009","MAN004","MAS001","MAF015","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0112135","Choice Easy Tier PPO Plus 500 with Care Complement","41304MA011","MAN005","MAS001","MAF019","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0112137","Choice Easy Tier PPO Plus 1000 25/40/300 with Care Complement","41304MA011","MAN005","MAS001","MAF019","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0112139","Choice Easy Tier PPO Plus 1500 with Care Complement","41304MA011","MAN005","MAS001","MAF019","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0112141","Choice Easy Tier PPO Plus 2000 25/40 with Care Complement","41304MA011","MAN005","MAS001","MAF019","Existing","PPO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0112143","Choice Easy Tier PPO Plus 2500 15%/35% with Care Complement","41304MA011","MAN005","MAS001","MAF023","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0112145","Choice Easy Tier PPO Plus 3000 with Care Complement","41304MA011","MAN005","MAS001","MAF015","Existing","PPO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","All covered services","Yes"]
["41304MA0172147","Allies Choice HMO 1000 25/50/350 with Care Complement","41304MA017","MAN006","MAS003","MAF009","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0172149","Allies Choice HMO 1500 25/50 ER350 with Care Complement","41304MA017","MAN006","MAS003","MAF021","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0172151","Allies Choice HMO 2000 20/40/400 with Care Complement","41304MA017","MAN006","MAS003","MAF021","Existing","HMO","Gold","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
["41304MA0172153","Allies Choice HMO 3000 40/55/500 with Care Complement","41304MA017","MAN006","MAS003","MAF014","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,null,"No","Allows Adult and Child-Only",null,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs",null,null,null,"01/01/2024",null,"Yes","Urgent and Emergency only","Yes","Urgent and Emergency only","No"]
[]
[]
[]
[]
[]
[]
[]
["Benefit Information",null,null,"General Information",null,null,null,null,null,null,"Out of Pocket Exceptions"]
["Benefits",null,"EHB","Is this Benefit Covered?","Quantitative Limit on Service","Limit Quantity","Limit Unit","Exclusions","Benefit Explanation","EHB Variance Reason","Excluded from In Network MOOP","Excluded from Out of Network MOOP"]
["Primary Care Visit to Treat an Injury or Illness",null,"Yes","Covered","No",null,null,null,"First 3 pediatric (under 19) visits at no charge.","Additional EHB Benefit","No","No"]
["Specialist Visit",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Hospice Services",null,"Yes","Covered","No",null,null,null,"Hospice services' means pain control and symptom relief and supportive and other care for a member who is terminally ill (the patient is expected to live six months or less).",null,"No","No"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,"Yes","Covered","No",null,null,null,"Only covers services to diagnose and treat infertility if unable to conceive after one year, or the member is age 35 or older and has not been able to conceive for 6 months; cryopreservation is covered if the member will undergo medical treatment which results in infertility. ",null,"No","No"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Covered","Yes","1","Exam(s) per Benefit Period",null,null,"Not EHB","No","No"]
["Urgent Care Centers or Facilities",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Home Health Care Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Emergency Room Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Emergency Transportation/Ambulance",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered","No",null,null,null,"In a Rehabilitation Hospital (60-day benefit limit per member per benefit period).",null,"No","No"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Bariatric Surgery",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Cosmetic Surgery",null,null,"Not Covered"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes","100","Days per Benefit Period",null,"Benefit limit per member.","Substantially Equal","No","No"]
["Prenatal and Postnatal Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered","No",null,null,null,"First 3 pediatric (under 19) visits at no charge.","Additional EHB Benefit","No","No"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered","No",null,null,null,"First 3 pediatric (under 19) visits at no charge.","Additional EHB Benefit","No","No"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Generic Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Preferred Brand Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Non-Preferred Brand Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Specialty Drugs",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"First 6 visits at no member cost up to 60 combined visit limit for physical therapy/occupational therapy per benefit period, but no benefit limit for speech therapy or when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health plan of care. ","Substantially Equal","No","No"]
["Habilitation Services",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"First 6 visits at no member cost up to 60 combined visit limit for physical therapy/occupational therapy per benefit period, but no benefit limit for speech therapy or when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health plan of care. ","Substantially Equal","No","No"]
["Chiropractic Care",null,"Yes","Covered","No",null,null,null,"This health plan covers outpatient chiropractic services when they are furnished for you by a chiropractor who is licensed to furnish the specific covered service. The first 6 visits are provided at no member cost. ",null,"No","No"]
["Durable Medical Equipment",null,"Yes","Covered","No",null,null,null,"One electric breast pump per birth (rented or purchased).","Substantially Equal","No","No"]
["Hearing Aids",null,"Yes","Covered","Yes","2000","Dollars per 3 Years",null,"$2,000 for one hearing aid for each hearing impaired ear every 36 months for members 21 years or younger.",null,"No","No"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered","Yes","1","Exam(s) per Benefit Period",null,"GYN exam limited to one exam per benefit period.","Substantially Equal","No","No"]
["Routine Foot Care",null,null,"Covered","No",null,null,null,"Covered for Diabetes and some circulatory diseases.","Not EHB","No","No"]
["Acupuncture",null,null,"Covered","Yes","20","Visit(s) per Benefit Period",null,"This plan covers the first 6 visits at no member cost up to 20 visits per benefit period.","Not EHB","No","No"]
["Weight Loss Programs",null,"Yes","Covered","Yes","6","Months per Year",null,"Coverage for six months of membership fees in a qualified weight-loss program for either a covered Subscriber or one covered Dependent (see MassGeneralBrighamHealthPlan.org for qualifications).","Substantially Equal","No","No"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes","1","Exam(s) per Benefit Period",null,"1 exam(s) per benefit period with no cost-sharing.","Substantially Equal","No","No"]
["Eye Glasses for Children",null,"Yes","Covered","Yes","1","Item(s) per Benefit Period",null,"1 pair eyeglasses per benefit period with no cost-sharing for a 'Collection Frame'. Contact lenses once per year in lieu of eyeglasses. ","Substantially Equal","No","No"]
["Dental Check-Up for Children",null,"Yes","Covered","Yes","2","Exam(s) per Benefit Period",null,"See Schedule of Benefits for more detail.","Substantially Equal","No","No"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes","60","Visit(s) per Benefit Period",null,"First 6 visits at no member cost sharing up to 60 visits combined outpatient physical and occupational therapy.","Substantially Equal","No","No"]
["Well Baby Visits and Care",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Basic Dental Care – Child",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Orthodontia – Child",null,null,"Covered","No",null,null,null,"Medically necessary orthodontia covered.","Additional EHB Benefit","No","No"]
["Major Dental Care – Child",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Basic Dental Care – Adult",null,null,"Not Covered"]
["Orthodontia – Adult",null,null,"Not Covered"]
["Major Dental Care – Adult",null,null,"Not Covered"]
["Abortion for Which Public Funding is Prohibited",null,null,"Covered","No",null,null,null,null,"Not EHB","No","No"]
["Transplant",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Accidental Dental",null,null,"Covered","No",null,null,null,"Covered when provided in an emergency room within 72 hours of an accident or injury.","Not EHB","No","No"]
["Dialysis",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Allergy Testing",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Chemotherapy",null,"Yes","Covered","No",null,null,null,"Coverage includes orally administered anticancer medication used to eliminate or slow the growth of cancerous cells.","Substantially Equal","No","No"]
["Radiation",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Diabetes Education",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Prosthetic Devices",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Infusion Therapy",null,"Yes","Covered","No",null,null,null,"Home infusion therapy that is furnished for you by a home infusion therapy provider. This includes: the infusion solution; the preparation of the solution; the equipment for its administration; and necessary part-time nursing.",null,"No","No"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered","No",null,null,null,null,null,"No","No"]
["Nutritional Counseling",null,"Yes","Covered","No",null,null,null,"First 8 visits covered at no member cost sharing for members diagnosed with diabetes.","Substantially Equal","No","No"]
["Reconstructive Surgery",null,"Yes","Covered","No",null,null,null,"This means non-dental surgery that is meant to improve or give you back bodily function or to correct a functional physical impairment that was caused by: a birth defect; developmental abnormality; a prior surgical procedure or disease; or an accidental injury. It also includes surgery that is done to correct a deformity or disfigurement that was caused by an accidental injury.","Substantially Equal","No","No"]
["Gender Affirming Care",null,null,"Covered","No",null,null,null,"Your plan covers gender affirming procedures for individuals when it is recommended by the member’s providers and when medically necessary.  Covered services include, but are not limited to, Facial Feminization/Masculinization, breast reconstruction surgery/mastectomy, and cryopreservation of eggs/embryos, and sperm. Member cost is based on type of service and treating provider. For a more complete list of Covered services, please refer to the Gender Affirming medical policy at Member.MassGeneralBrighamHealthPlan.org.\n\n","Not EHB","No","No"]

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["All fields with an asterisk (*) are required",null,null,null,null,null,null,null,null,null,null,null,null,"SBC Scenario",null,null,null,null,null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Drug EHB Benefits",null,null,null,null,null,null,null,"Maximum Out of Pocket for Medical and Drug EHB Benefits (Total)",null,null,null,null,null,null,null,"Medical EHB Deductible",null,null,null,null,null,null,null,null,null,"Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"Combined Medical and Drug EHB Deductible",null,null,null,null,null,null,null,null,null,"HSA/HRA Detail",null,null,"AV Calculator Additional Benefit Design",null,null,null,null,null,null,"custom 1",null,null,null,null,null,null,null,"custom 2",null,null,null,null,null,null,null,"custom 3",null,null,null,null,null,null,null,"Primary Care Visit to Treat an Injury or Illness",null,null,null,null,null,"Specialist Visit",null,null,null,null,null,"Other Practitioner Office Visit (Nurse, Physician Assistant)",null,null,null,null,null,"Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,null,null,null,null,"Outpatient Surgery Physician/Surgical Services",null,null,null,null,null,"Hospice Services",null,null,null,null,null,"Infertility Treatment",null,null,null,null,null,"Routine Eye Exam (Adult)",null,null,null,null,null,"Urgent Care Centers or Facilities",null,null,null,null,null,"Home Health Care Services",null,null,null,null,null,"Emergency Room Services",null,null,null,null,null,"Emergency Transportation/Ambulance",null,null,null,null,null,"Inpatient Hospital Services (e.g., Hospital Stay)",null,null,null,null,null,"Inpatient Physician and Surgical Services",null,null,null,null,null,"Bariatric Surgery",null,null,null,null,null,"Skilled Nursing Facility",null,null,null,null,null,"Prenatal and Postnatal Care",null,null,null,null,null,"Delivery and All Inpatient Services for Maternity Care",null,null,null,null,null,"Mental/Behavioral Health Outpatient Services",null,null,null,null,null,"Mental/Behavioral Health Inpatient Services",null,null,null,null,null,"Substance Abuse Disorder Outpatient Services",null,null,null,null,null,"Substance Abuse Disorder Inpatient Services",null,null,null,null,null,"Generic Drugs",null,null,null,null,null,"Preferred Brand Drugs",null,null,null,null,null,"Non-Preferred Brand Drugs",null,null,null,null,null,"Specialty Drugs",null,null,null,null,null,"Outpatient Rehabilitation Services",null,null,null,null,null,"Habilitation Services",null,null,null,null,null,"Chiropractic Care",null,null,null,null,null,"Durable Medical Equipment",null,null,null,null,null,"Hearing Aids",null,null,null,null,null,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",null,null,null,null,null,"Routine Foot Care",null,null,null,null,null,"Acupuncture",null,null,null,null,null,"Weight Loss Programs",null,null,null,null,null,"Routine Eye Exam for Children",null,null,null,null,null,"Eye Glasses for Children",null,null,null,null,null,"Dental Check-Up for Children",null,null,null,null,null,"Rehabilitative Speech Therapy",null,null,null,null,null,"Rehabilitative Occupational and Rehabilitative Physical Therapy",null,null,null,null,null,"Well Baby Visits and Care",null,null,null,null,null,"Laboratory Outpatient and Professional Services",null,null,null,null,null,"X-rays and Diagnostic Imaging",null,null,null,null,null,"Basic Dental Care – Child",null,null,null,null,null,"Orthodontia – Child",null,null,null,null,null,"Major Dental Care – Child",null,null,null,null,null,"Abortion for Which Public Funding is Prohibited",null,null,null,null,null,"Transplant",null,null,null,null,null,"Accidental Dental",null,null,null,null,null,"Dialysis",null,null,null,null,null,"Allergy Testing",null,null,null,null,null,"Chemotherapy",null,null,null,null,null,"Radiation",null,null,null,null,null,"Diabetes Education",null,null,null,null,null,"Prosthetic Devices",null,null,null,null,null,"Infusion Therapy",null,null,null,null,null,"Treatment for Temporomandibular Joint Disorders",null,null,null,null,null,"Nutritional Counseling",null,null,null,null,null,"Reconstructive Surgery",null,null,null,null,null,"Gender Affirming Care"]
["Plan Cost Sharing Attributes",null,null,null,null,null,null,null,null,null,null,null,null,"Having a Baby",null,null,null,"Having Diabetes",null,null,null,"Treatment of a Simple Fracture",null,null,null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,null,"In Network (Tier 2)",null,null,"Out of Network",null,"Combined In/Out Network",null,null,null,null,null,null,null,null,null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"In Network",null,"In Network (Tier 2)",null,"Out of Network",null,"Combined In/Out Network",null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance",null,null,"Copay",null,null,"Coinsurance"]
["HIOS Plan ID \n(Standard Component + Variant)","Plan Variant Marketing Name*","Level of Coverage\n(Metal Level)","CSR Variation Type","Issuer Actuarial Value","AV Calculator Output Number*","Medical & Drug Deductibles Integrated?*","Medical & Drug Maximum Out of Pocket Integrated?*","Is a Referral Required for Specialist?*","Specialist(s) Requiring a Referral","Multiple In Network Tiers?*","1st Tier Utilization*","2nd Tier Utilization","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Deductible*","Copayment*","Coinsurance*","Limit*","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","Individual","Family","Default Coinsurance","Individual","Family","Default Coinsurance","Individual","Family","Individual","Family","HSA Eligible*","HSA/HRA Employer Contribution","HSA/HRA Employer Contribution Amount","Maximum Coinsurance for Specialty Drugs","Maximum Number of Days for Charging an Inpatient Copay?","Begin Primary Care Cost-Sharing After a Set Number of Visits?","Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays?","Blank","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","Individual","Family","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network","In Network (Tier 1)","In Network (Tier 2)","Out of Network"]
["41304MA0042063-00","Complete HMO 20/40 with Care Complement","Platinum","Standard Platinum Off Exchange Plan",0.88990000000000002,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,0,600,0,0,0,600,0,0,0,300,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3500,"$3500 per person | $7000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,40,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,160,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,300,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.25,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"Not Applicable",null,"Not Applicable",0.5,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,150,null,150,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable",0.2,null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1]
["41304MA0042065-00","Complete HMO 500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.79369999999999996,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,500,800,0,0,0,900,0,0,300,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",500,"$500 per person | $1000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,45,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042067-00","Complete HMO 1000 25/50/350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.7923,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,1000,700,0,0,100,800,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000,"$1000 per person | $2000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,50,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042069-00","Complete HMO 1000 10%/30% with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78459999999999996,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,1000,200,2100,0,400,600,0,0,1000,100,300,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1000,"$1000 per person | $2000 per group",0.3,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,40,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1]
["41304MA0042071-00","Complete HMO 1500 25/50 ER350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78639999999999999,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,1500,600,0,0,100,700,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1500,"$1500 per person | $3000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,50,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042073-00","Complete HMO 2000 20/40/400 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78580000000000005,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,600,0,0,100,600,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,40,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,400,null,400,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,20,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,400,null,400,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042075-00","Complete HMO 2000 30/60/1000 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.7198,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,800,0,0,100,1100,0,0,1100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$600.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"$1000.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$600.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"$1000.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042077-00","Complete HMO 2500 30/55/500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71130000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2500,600,0,0,400,800,0,0,1100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,35,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042079-00","Complete HMO 2500 15%/35% with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71540000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2500,60,2100,0,400,700,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.35,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","15.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"Not Applicable","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"Not Applicable","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1]
["41304MA0042081-00","Complete HMO 3000 40/55/500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.70699999999999996,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3000,600,0,0,100,900,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,55,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,35,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042083-00","Complete HMO 4000 35/45/750 10% with Care Complement","Expanded Bronze","Standard Bronze Off Exchange Plan",0.64980000000000004,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,4000,60,400,0,900,900,0,0,2400,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",4000,"$4000 per person | $8000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"$45.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,45,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1]
["41304MA0042085-00","Complete HMO 5000 35/45/750 10% with Care Complement","Expanded Bronze","Standard Bronze Off Exchange Plan",0.64739999999999998,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,5000,60,300,0,900,900,0,0,2400,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100,"$9100 per person | $18200 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",5000,"$5000 per person | $10000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"$45.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,45,null,"Not Applicable","Not Applicable",null,1,175,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,1]
["41304MA0042157-00","Complete HMO 2000 25/60 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71840000000000004,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,2000,1100,0,0,100,800,0,0,2000,200,5,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2000,"$2000 per person | $4000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,60,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,30,null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$700.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$25.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$350.00 Copay after deductible",null,"$350.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,60,null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0042159-00","Complete HMO 3500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.68489999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","No",1,null,3500,1600,0,0,100,1200,0,0,2100,200,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3500,"$3500 per person | $7000 per group",0.2,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,75,null,75,"Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge after deductible",null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,1,100,null,"Not Applicable","Not Applicable",null,1,"$225.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"Not Applicable","Not Applicable",null,1,"$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1]
["41304MA0072093-00","Complete PPO Plus 500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.79369999999999996,null,"No","Yes","No",null,"No",1,null,500,800,0,0,0,900,0,0,300,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",500,"$500 per person | $1000 per group",0.2,null,null,null,1000,"$1000 per person | $2000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",500,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072095-00","Complete PPO Plus 1000 25/50/350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.7923,null,"No","Yes","No",null,"No",1,null,1000,700,0,0,100,800,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",1000,"$1000 per person | $2000 per group",0.2,null,null,null,2000,"$2000 per person | $4000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072097-00","Complete PPO Plus 1000 10%/30% with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78459999999999996,null,"Yes","Yes","No",null,"No",1,null,1000,200,2100,0,400,600,0,0,1000,100,300,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1000,"$1000 per person | $2000 per group",0.3,null,null,null,2000,"$2000 per person | $4000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,1,40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","30.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible"]
["41304MA0072099-00","Complete PPO Plus 1500 25/50 ER350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78639999999999999,null,"No","Yes","No",null,"No",1,null,1500,600,0,0,100,700,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",1500,"$1500 per person | $3000 per group",0.2,null,null,null,3000,"$3000 per person | $6000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",25,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",350,null,350,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072101-00","Complete PPO Plus 2000 20/40/400 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78580000000000005,null,"No","Yes","No",null,"No",1,null,2000,600,0,0,100,600,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",null,null,18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,null,null,null,4000,"$4000 per person | $8000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",400,null,400,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",20,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",400,null,400,"Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072103-00","Complete PPO Plus 2000 30/60/1000 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.7198,null,"No","Yes","No",null,"No",1,null,2000,800,0,0,100,1100,0,0,1100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,null,null,null,4000,"$4000 per person | $8000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$600.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"$1000.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$600.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$60.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"$1000.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",60,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072105-00","Complete PPO Plus 2500 30/55/500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71130000000000004,null,"Yes","Yes","No",null,"No",1,null,2500,600,0,0,400,800,0,0,1100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100,"$9100 per person | $18200 per group",null,null,18200,"$18200 per person | $36400 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.2,null,null,null,5000,"$5000 per person | $10000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",35,null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$400.00 Copay after deductible",null,"$400.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072107-00","Complete PPO Plus 2500 15%/35% with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71540000000000004,null,"Yes","Yes","No",null,"No",1,null,2500,60,2100,0,400,700,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.35,null,null,null,5000,"$5000 per person | $10000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","15.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",30,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"35.00% Coinsurance after deductible","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","35.00% Coinsurance after deductible",null,"50.00% Coinsurance after deductible"]
["41304MA0072109-00","Complete PPO Plus 3000 40/55/500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.70699999999999996,null,"Yes","Yes","No",null,"No",1,null,3000,600,0,0,100,900,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,null,null,null,6000,"$6000 per person | $12000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",35,null,"Not Applicable","Not Applicable",null,1,75,null,"Not Applicable","Not Applicable",null,1,"$300.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",40,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$55.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"$500.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$80.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",55,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0072111-00","Complete PPO Plus 4000 35/45/750 10% with Care Complement","Expanded Bronze","Standard Bronze Off Exchange Plan",0.64980000000000004,null,"No","Yes","No",null,"No",1,null,4000,60,400,0,900,900,0,0,2400,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",4000,"$4000 per person | $8000 per group",0.2,null,null,null,8000,"$8000 per person | $16000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,1,200,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible"]
["41304MA0072113-00","Complete PPO Plus 5000 35/45/750 10% with Care Complement","Expanded Bronze","Standard Bronze Off Exchange Plan",0.64739999999999998,null,"No","Yes","No",null,"No",1,null,5000,60,300,0,900,900,0,0,2400,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100,"$9100 per person | $18200 per group",null,null,18200,"$18200 per person | $36400 per group","Not Applicable","per person not applicable | per group not applicable",5000,"$5000 per person | $10000 per group",0.2,null,null,null,10000,"$10000 per person | $20000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,null,null,null,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1000.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,1,175,null,"Not Applicable","Not Applicable",null,1,250,null,"Not Applicable","Not Applicable",null,1,500,null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$35.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$50.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$100.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$45.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","10.00% Coinsurance after deductible",null,"30.00% Coinsurance after deductible"]
["41304MA0072163-00","Complete PPO Plus 3500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.68489999999999995,null,"Yes","Yes","No",null,"No",1,null,3500,1600,0,0,100,1200,0,0,2100,200,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",null,null,18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3500,"$3500 per person | $7000 per group",0.2,null,null,null,7000,"$7000 per person | $14000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge after deductible",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay per Stay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",45,null,"Not Applicable","Not Applicable",null,1,100,null,"Not Applicable","Not Applicable",null,1,"$225.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",50,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,1,"$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$75.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","25.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"Not Applicable",null,"Not Applicable","50.00% Coinsurance after deductible",null,1,"No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$750.00 Copay after deductible",null,"$750.00 Copay after deductible","Not Applicable",null,"Not Applicable","No Charge",null,"No Charge after deductible","Not Applicable",null,"Not Applicable","$150.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","Not Applicable",null,"Not Applicable","20.00% Coinsurance after deductible",null,"20.00% Coinsurance after deductible","No Charge",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible",75,null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible","$1500.00 Copay after deductible",null,"Not Applicable","Not Applicable",null,"20.00% Coinsurance after deductible"]
["41304MA0092121-00","Choice Easy Tier HMO 500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.79420000000000002,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,500,700,0,0,100,700,0,0,500,600,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",500,"$500 per person | $1000 per group",0.2,500,"$500 per person | $1000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable",40,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","$450.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0092123-00","Choice Easy Tier HMO 1000 25/40/300 With Care Complement","Gold","Standard Gold Off Exchange Plan",0.79069999999999996,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,1000,700,0,0,100,700,0,0,400,400,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000,"$1000 per person | $2000 per group",0.2,1000,"$1000 per person | $2000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable",40,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$20.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0092125-00","Choice Easy Tier HMO 1500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78449999999999998,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,1500,600,0,0,100,700,0,0,400,400,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1500,"$1500 per person | $3000 per group",0.2,1500,"$1500 per person | $3000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable",40,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$20.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0092127-00","Choice Easy Tier HMO 2000 25/40 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78239999999999998,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,2000,600,0,0,100,700,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,2000,"$2000 per person | $4000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable",40,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0092129-00","Choice Easy Tier HMO 2500 15%/35% with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71460000000000001,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,2500,60,900,0,400,900,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.15,2500,"$2500 per person | $5000 per group",0.35,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","15.00% Coinsurance after deductible",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable",55,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","15.00% Coinsurance after deductible","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","15.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable",1,35,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$100.00 Copay after deductible","$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","15.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$100.00 Copay after deductible","$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1,"Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible",1]
["41304MA0092131-00","Choice Easy Tier HMO 3000 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71799999999999997,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,3000,600,0,0,100,1000,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,3000,"$3000 per person | $6000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable",55,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$750.00 Copay after deductible","Not Applicable","$750.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,35,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$150.00 Copay after deductible","$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$750.00 Copay after deductible","Not Applicable","$750.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$150.00 Copay after deductible","$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0092133-00","Choice Easy Tier HMO 2500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.68330000000000002,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,2500,600,0,0,1100,400,0,0,2400,5,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.2,2500,"$2500 per person | $5000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$800.00 Copay after deductible","Not Applicable","$800.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$90.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$180.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$450.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$30.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$25.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$25.00 Copay after deductible","$125.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$800.00 Copay after deductible","Not Applicable","$800.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$25.00 Copay after deductible","$125.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0112135-00","Choice Easy Tier PPO Plus 500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.79420000000000002,null,"No","Yes","No",null,"Yes",0.6,0.4,500,700,0,0,100,700,0,0,500,600,60,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group",18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",500,"$500 per person | $1000 per group",0.2,500,"$500 per person | $1000 per group",0.2,1000,"$1000 per person | $2000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","$450.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$35.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible"]
["41304MA0112137-00","Choice Easy Tier PPO Plus 1000 25/40/300 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.79069999999999996,null,"No","Yes","No",null,"Yes",0.6,0.4,1000,800,0,0,0,800,0,0,1000,500,50,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group",18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",1000,"$1000 per person | $2000 per group",0.2,1000,"$1000 per person | $2000 per group",0.2,2000,"$2000 per person | $4000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible"]
["41304MA0112139-00","Choice Easy Tier PPO Plus 1500 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78449999999999998,null,"No","Yes","No",null,"Yes",0.6,0.4,1500,600,0,0,100,700,0,0,400,400,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group",18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",1500,"$1500 per person | $3000 per group",0.2,1500,"$1500 per person | $3000 per group",0.2,3000,"$3000 per person | $6000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$20.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",300,"Not Applicable",300,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$35.00 Copay after deductible","$135.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible"]
["41304MA0112141-00","Choice Easy Tier PPO Plus 2000 25/40 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78239999999999998,null,"No","Yes","No",null,"Yes",0.6,0.4,2000,600,0,0,100,700,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group",18000,"$18000 per person | $36000 per group","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,2000,"$2000 per person | $4000 per group",0.2,4000,"$4000 per person | $8000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$75.00 Copay after deductible","$525.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$40.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible"]
["41304MA0112143-00","Choice Easy Tier PPO Plus 2500 15%/35% with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71460000000000001,null,"Yes","Yes","No",null,"Yes",0.6,0.4,2500,60,900,0,400,900,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group",18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2500,"$2500 per person | $5000 per group",0.2,2000,"$2000 per person | $5000 per group",0.2,5000,"$5000 per person | $10000 per group","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","15.00% Coinsurance after deductible","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible",35,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$100.00 Copay after deductible","$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","Not Applicable","15.00% Coinsurance after deductible","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$100.00 Copay after deductible","$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","15.00% Coinsurance after deductible","35.00% Coinsurance after deductible","35.00% Coinsurance after deductible"]
["41304MA0112145-00","Choice Easy Tier PPO Plus 3000 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.71799999999999997,null,"No","Yes","No",null,"Yes",0.6,0.4,3000,600,0,0,100,1000,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group",18900,"$18900 per person | $37800 per group","Not Applicable","per person not applicable | per group not applicable",3000,"$3000 per person | $6000 per group",0.2,3000,"$3000 per person | $6000 per group",0.2,6000,"$6000 per person | $12000 per group","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$250.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$750.00 Copay after deductible","Not Applicable","$750.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",35,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,300,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",45,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$1500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$55.00 Copay after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$150.00 Copay after deductible","$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$750.00 Copay after deductible","Not Applicable","$750.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$150.00 Copay after deductible","$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable","20.00% Coinsurance after deductible","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible",55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible"]
["41304MA0172147-00","Allies Choice HMO 1000 25/50/350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78639999999999999,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,1000,700,0,0,100,800,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000,"$1000 per person | $2000 per group",0.2,1000,"$1000 per person | $2000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable",50,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,350,"Not Applicable",350,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,30,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,350,"Not Applicable",350,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0172149-00","Allies Choice HMO 1500 25/50 ER350 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78110000000000002,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,1500,600,0,0,100,700,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1500,"$1500 per person | $3000 per group",0.2,1500,"$1500 per person | $3000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable",50,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,350,"Not Applicable",350,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,25,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,50,80,"Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,350,"Not Applicable",350,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,50,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0172151-00","Allies Choice HMO 2000 20/40/400 with Care Complement","Gold","Standard Gold Off Exchange Plan",0.78039999999999998,null,"No","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,2000,600,0,0,100,600,0,0,400,500,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9000,"$9000 per person | $18000 per group",9000,"$9000 per person | $18000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",2000,"$2000 per person | $4000 per group",0.2,2000,"$2000 per person | $4000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0,"$0 per person | $0 per group",0,0,"$0 per person | $0 per group",0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,"No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable",40,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,200,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,500,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,80,"Not Applicable","Not Applicable","Not Applicable",1,40,80,"Not Applicable","Not Applicable","Not Applicable",1,20,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$250.00 Copay after deductible","$1250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,80,"Not Applicable","Not Applicable","Not Applicable",1,40,80,"Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,400,"Not Applicable",400,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$50.00 Copay after deductible","$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]
["41304MA0172153-00","Allies Choice HMO 3000 40/55/500 with Care Complement","Silver","Standard Silver Off Exchange Plan",0.70509999999999995,null,"Yes","Yes","Yes","All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.","Yes",0.6,0.4,3000,600,0,0,100,900,0,0,2100,100,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9450,"$9450 per person | $18900 per group",9450,"$9450 per person | $18900 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3000,"$3000 per person | $6000 per group",0.2,3000,"$3000 per person | $6000 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No","No",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$300.00 Copay after deductible","$1300.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable",55,"Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","Not Applicable","$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge after deductible","Not Applicable","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable","$500.00 Copay per Stay after deductible","$2000.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge after deductible","No Charge after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,35,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,75,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$300.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,80,"Not Applicable","Not Applicable","Not Applicable",1,55,80,"Not Applicable","Not Applicable","Not Applicable",1,40,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$300.00 Copay after deductible","$1300.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,80,"Not Applicable","Not Applicable","Not Applicable",1,55,80,"Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$55.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$80.00 Copay after deductible","$180.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","Not Applicable","$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$80.00 Copay after deductible","$180.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1,"No Charge","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,55,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1,"$500.00 Copay after deductible","$2000.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1]