{"text_format":"1","workbook":"xlsx","n_sheets":34,"sheets":["EnableMacros","Benefits Package 1","Cost Share Variances 1","Benefits Package 2","Cost Share Variances 2","Benefits Package 3","Cost Share Variances 3","Benefits Package 4","Cost Share Variances 4","Benefits Package 5","Cost Share Variances 5","Benefits Package 6","Cost Share Variances 6","Benefits Package 7","Cost Share Variances 7","Benefits Package 8","Cost Share Variances 8","Benefits Package 9","Cost Share Variances 9","Benefits Package 10","Cost Share Variances 10","Benefits Package 11","Cost Share Variances 11","Benefits Package 12","Cost Share Variances 12","Benefits Package 13","Cost Share Variances 13","Benefits Package 14","Cost Share Variances 14","Benefits Package 15","Cost Share Variances 15","DefaultBP","DefaultCSV","Names"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":100,"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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["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010050","Bronze Classic Standard HMO $7500 $50","58081GA001","GAN001","GAS001","GAF002","Existing","HMO","Expanded Bronze","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010052","Silver Classic Standard HMO $6000 $40","58081GA001","GAN001","GAS001","GAF004","Existing","HMO","Silver","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010053","Gold Classic Standard HMO $2000 $30","58081GA001","GAN001","GAS001","GAF003","Existing","HMO","Gold","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010055","Buena Salud Plateado Estandar Clasico HMO $6000 $40","58081GA001","GAN001","GAS001","GAF004","Existing","HMO","Silver","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010059","Buena Salud Bronce Estandar Clasico HMO $7500 $50","58081GA001","GAN001","GAS001","GAF002","New","HMO","Expanded Bronze","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

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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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010050-00","Bronze Classic Standard HMO $7500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010050-01","Bronze Classic Standard HMO $7500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010050-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010050-03","Bronze Classic Standard HMO $7500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-00","Silver Classic Standard HMO $6000 $40","Silver","Standard Silver Off Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-01","Silver Classic Standard HMO $6000 $40","Silver","Standard Silver On Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010052-03","Silver Classic Standard HMO $6000 $40","Silver","Limited Cost Sharing Plan Variation",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-04","Silver Classic Standard CSR 250 HMO $3000 $40","Silver","73% AV Level Silver Plan",null,0.730702360935441,"Yes","Yes","No",null,"No",1.0,null,3000.0,20.0,3300.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7400.0,"$7400 per person | $14800 per group",7400.0,"$7400 per person | $14800 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,3000.0,"$3000 per person | $6000 per group",0.4,3000.0,"$3000 per person | $6000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-05","Silver Classic Standard CSR 200 HMO $700 $20","Silver","87% AV Level Silver Plan",null,0.870442632272473,"Yes","Yes","No",null,"No",1.0,null,700.0,0.0,2600.0,0.0,100.0,900.0,0.0,0.0,700.0,100.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3300.0,"$3300 per person | $6600 per group",3300.0,"$3300 per person | $6600 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,700.0,"$700 per person | $1400 per group",0.3,700.0,"$700 per person | $1400 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010052-06","Silver Classic Standard CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.941107499644086,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,2200.0,0.0,0.0,500.0,30.0,0.0,0.0,20.0,600.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2200.0,"$2200 per person | $4400 per group",2200.0,"$2200 per person | $4400 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,0.0,"$0 per person | $0 per group",0.25,0.0,"$0 per person | $0 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0]
["58081GA0010053-00","Gold Classic Standard HMO $2000 $30","Gold","Standard Gold Off Exchange Plan",null,0.780377922702016,"Yes","Yes","No",null,"No",1.0,null,2000.0,20.0,2300.0,0.0,100.0,1100.0,0.0,0.0,2000.0,200.0,60.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8200.0,"$8200 per person | $16400 per group",8200.0,"$8200 per person | $16400 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,2000.0,"$2000 per person | $4000 per group",0.25,2000.0,"$2000 per person | $4000 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,15.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,250.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010053-01","Gold Classic Standard HMO $2000 $30","Gold","Standard Gold On Exchange Plan",null,0.780377922702016,"Yes","Yes","No",null,"No",1.0,null,2000.0,20.0,2300.0,0.0,100.0,1100.0,0.0,0.0,2000.0,200.0,60.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8200.0,"$8200 per person | $16400 per group",8200.0,"$8200 per person | $16400 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,2000.0,"$2000 per person | $4000 per group",0.25,2000.0,"$2000 per person | $4000 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,15.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,250.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010053-02","Gold AIAN HMO $0 $0","Gold","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010053-03","Gold Classic Standard HMO $2000 $30","Gold","Limited Cost Sharing Plan Variation",null,0.780377922702016,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8200.0,"$8200 per person | $16400 per group",8200.0,"$8200 per person | $16400 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,2000.0,"$2000 per person | $4000 per group",0.25,2000.0,"$2000 per person | $4000 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,15.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,250.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-00","Buena Salud Plateado Estandar Clasico HMO $6000 $40","Silver","Standard Silver Off Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-01","Buena Salud Plateado Estandar Clasico HMO $6000 $40","Silver","Standard Silver On Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010055-03","Buena Salud Plateado Estandar Clasico HMO $6000 $40","Silver","Limited Cost Sharing Plan Variation",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-04","Buena Salud Plateado Estandar Clasico CSR 250 HMO $3000 $40","Silver","73% AV Level Silver Plan",null,0.730702360935441,"Yes","Yes","No",null,"No",1.0,null,3000.0,20.0,3300.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7400.0,"$7400 per person | $14800 per group",7400.0,"$7400 per person | $14800 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,3000.0,"$3000 per person | $6000 per group",0.4,3000.0,"$3000 per person | $6000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-05","Buena Salud Plateado Estandar Clasico CSR 200 HMO $700 $20","Silver","87% AV Level Silver Plan",null,0.870442632272473,"Yes","Yes","No",null,"No",1.0,null,700.0,0.0,2600.0,0.0,100.0,900.0,0.0,0.0,700.0,100.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3300.0,"$3300 per person | $6600 per group",3300.0,"$3300 per person | $6600 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,700.0,"$700 per person | $1400 per group",0.3,700.0,"$700 per person | $1400 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010055-06","Buena Salud Plateado Estandar Clasico CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.941107499644086,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,2200.0,0.0,0.0,500.0,30.0,0.0,0.0,20.0,600.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2200.0,"$2200 per person | $4400 per group",2200.0,"$2200 per person | $4400 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,0.0,"$0 per person | $0 per group",0.25,0.0,"$0 per person | $0 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0]
["58081GA0010059-00","Buena Salud Bronce Estandar Clasico HMO $7500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010059-01","Buena Salud Bronce Estandar Clasico HMO $7500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010059-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010059-03","Buena Salud Bronce Estandar Clasico HMO $7500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]

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["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010015","Silver Simple HMO $5000 $20","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Silver","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010021","Bronze Classic Saver Plus HMO $8000 $0","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010024","Bronze Classic 4700 HMO $4700 $70","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010025","Silver Simple Saver HMO $5750 $10","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Silver","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010030","Silver Elite Saver Plus HMO $0 $70","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Silver","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010035","Gold Elite Saver Plus HMO $1000 $10","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Gold","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010051","Bronze Simple 2 HMO $9150 10%","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 2","index":4,"n_rows":40,"n_cols":419,"rows_kept":40,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010015-00","Silver Simple HMO $5000 $20","Silver","Standard Silver Off Exchange Plan",null,0.7025638761910687,"Yes","Yes","No",null,"Yes",0.44,0.56,5000.0,200.0,2600.0,0.0,0.0,1900.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,5000.0,"$5000 per person | $10000 per group",0.5,5000.0,"$5000 per person | $10000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010015-01","Silver Simple HMO $5000 $20","Silver","Standard Silver On Exchange Plan",null,0.7025638761910687,"Yes","Yes","No",null,"Yes",0.44,0.56,5000.0,200.0,2600.0,0.0,0.0,1900.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,5000.0,"$5000 per person | $10000 per group",0.5,5000.0,"$5000 per person | $10000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010015-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010015-03","Silver Simple HMO $5000 $20","Silver","Limited Cost Sharing Plan Variation",null,0.7025638761910687,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,5000.0,"$5000 per person | $10000 per group",0.5,5000.0,"$5000 per person | $10000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010015-04","Silver Simple CSR 250 HMO $4100 $20","Silver","73% AV Level Silver Plan",null,0.7325774760894599,"Yes","Yes","No",null,"Yes",0.44,0.56,4100.0,200.0,2500.0,0.0,0.0,1900.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7800.0,"$7800 per person | $15600 per group",7800.0,"$7800 per person | $15600 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,4100.0,"$4100 per person | $8200 per group",0.4,4100.0,"$4100 per person | $8200 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,15.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010015-05","Silver Simple CSR 200 HMO $800 $15","Silver","87% AV Level Silver Plan",null,0.873313448284795,"Yes","Yes","No",null,"Yes",0.44,0.56,800.0,200.0,1800.0,0.0,0.0,1600.0,0.0,0.0,800.0,300.0,300.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2800.0,"$2800 per person | $5600 per group",2800.0,"$2800 per person | $5600 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,800.0,"$800 per person | $1600 per group",0.25,800.0,"$800 per person | $1600 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,3.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$40.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$40.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"$40.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$40.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$30.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010015-06","Silver Simple CSR 150 HMO $0 $5","Silver","94% AV Level Silver Plan",null,0.9413032391328564,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,60.0,1800.0,0.0,0.0,800.0,0.0,0.0,0.0,70.0,400.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1900.0,"$1900 per person | $3800 per group",1900.0,"$1900 per person | $3800 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,0.0,"$0 per person | $0 per group",0.2,0.0,"$0 per person | $0 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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0]
["58081GA0010021-00","Bronze Classic Saver Plus HMO $8000 $0","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,8000.0,200.0,1100.0,0.0,4500.0,200.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010021-01","Bronze Classic Saver Plus HMO $8000 $0","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,8000.0,200.0,1100.0,0.0,4500.0,200.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010021-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010021-03","Bronze Classic Saver Plus HMO $8000 $0","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010024-00","Bronze Classic 4700 HMO $4700 $70","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,4700.0,200.0,2800.0,0.0,4200.0,700.0,0.0,0.0,2200.0,500.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010024-01","Bronze Classic 4700 HMO $4700 $70","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,4700.0,200.0,2800.0,0.0,4200.0,700.0,0.0,0.0,2200.0,500.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010024-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010024-03","Bronze Classic 4700 HMO $4700 $70","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-00","Silver Simple Saver HMO $5750 $10","Silver","Standard Silver Off Exchange Plan",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,5750.0,0.0,2200.0,0.0,100.0,2200.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-01","Silver Simple Saver HMO $5750 $10","Silver","Standard Silver On Exchange Plan",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,5750.0,0.0,2200.0,0.0,100.0,2200.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010025-03","Silver Simple Saver HMO $5750 $10","Silver","Limited Cost Sharing Plan Variation",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-04","Silver Simple Saver CSR 250 HMO $4750 $10","Silver","73% AV Level Silver Plan",null,0.7306718224942512,"Yes","Yes","No",null,"Yes",0.44,0.56,4750.0,0.0,2600.0,0.0,100.0,1900.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7780.0,"$7780 per person | $15560 per group",7780.0,"$7780 per person | $15560 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,4750.0,"$4750 per person | $9500 per group",0.4,4750.0,"$4750 per person | $9500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-05","Silver Simple Saver CSR 200 HMO $800 $10","Silver","87% AV Level Silver Plan",null,0.8702603722057195,"Yes","Yes","No",null,"Yes",0.44,0.56,800.0,0.0,2700.0,0.0,100.0,1200.0,0.0,0.0,800.0,90.0,700.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3100.0,"$3100 per person | $6200 per group",3100.0,"$3100 per person | $6200 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,800.0,"$800 per person | $1600 per group",0.4,800.0,"$800 per person | $1600 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010025-06","Silver Simple Saver CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.9401873680893513,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,2200.0,0.0,0.0,900.0,20.0,0.0,0.0,20.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2100.0,"$2100 per person | $4200 per group",2100.0,"$2100 per person | $4200 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,0.0,"$0 per person | $0 per group",0.2,0.0,"$0 per person | $0 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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0]
["58081GA0010030-00","Silver Elite Saver Plus HMO $0 $70","Silver","Standard Silver Off Exchange Plan",null,0.7001904526744441,"No","Yes","No",null,"Yes",0.44,0.56,0.0,400.0,5000.0,0.0,0.0,3000.0,0.0,0.0,0.0,600.0,1100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100.0,"$9100 per person | $18200 per group",9100.0,"$9100 per person | $18200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",500.0,"$500 per person | $1000 per group",0.5,500.0,"$500 per person | $1000 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,135.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0]
["58081GA0010030-01","Silver Elite Saver Plus HMO $0 $70","Silver","Standard Silver On Exchange Plan",null,0.7001904526744441,"No","Yes","No",null,"Yes",0.44,0.56,0.0,400.0,5000.0,0.0,0.0,3000.0,0.0,0.0,0.0,600.0,1100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100.0,"$9100 per person | $18200 per group",9100.0,"$9100 per person | $18200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",500.0,"$500 per person | $1000 per group",0.5,500.0,"$500 per person | $1000 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,135.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0]
["58081GA0010030-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,"No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010030-03","Silver Elite Saver Plus HMO $0 $70","Silver","Limited Cost Sharing Plan Variation",null,0.7001904526744441,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9100.0,"$9100 per person | $18200 per group",9100.0,"$9100 per person | $18200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",500.0,"$500 per person | $1000 per group",0.5,500.0,"$500 per person | $1000 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,135.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0]
["58081GA0010030-04","Silver Elite Saver Plus CSR 250 HMO $0 $55","Silver","73% AV Level Silver Plan",null,0.7370078745597038,"No","Yes","No",null,"Yes",0.44,0.56,0.0,400.0,5000.0,0.0,0.0,3000.0,0.0,0.0,0.0,600.0,1100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8450.0,"$8450 per person | $16900 per group",8450.0,"$8450 per person | $16900 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",250.0,"$250 per person | $500 per group",0.5,250.0,"$250 per person | $500 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",0.5,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,55.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0]
["58081GA0010030-05","Silver Elite Saver Plus CSR 200 HMO $0 $15","Silver","87% AV Level Silver Plan",null,0.8749697814717599,"No","Yes","No",null,"Yes",0.44,0.56,0.0,200.0,3000.0,0.0,0.0,1800.0,0.0,0.0,0.0,300.0,600.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3200.0,"$3200 per person | $6400 per group",3200.0,"$3200 per person | $6400 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.3,0.0,"$0 per person | $0 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",150.0,"$150 per person | $300 per group",0.5,150.0,"$150 per person | $300 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0]
["58081GA0010030-06","Silver Elite Saver Plus CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.9448847788036312,"No","Yes","No",null,"Yes",0.44,0.56,0.0,60.0,1500.0,0.0,0.0,800.0,0.0,0.0,0.0,70.0,400.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1600.0,"$1600 per person | $3200 per group",1600.0,"$1600 per person | $3200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.2,0.0,"$0 per person | $0 per group",0.2,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",50.0,"$50 per person | $100 per group",0.5,50.0,"$50 per person | $100 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0]
["58081GA0010035-00","Gold Elite Saver Plus HMO $1000 $10","Gold","Standard Gold Off Exchange Plan",null,0.8043559182569029,"No","Yes","No",null,"Yes",0.44,0.56,1000.0,200.0,2700.0,0.0,200.0,1800.0,0.0,0.0,1000.0,200.0,300.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8500.0,"$8500 per person | $17000 per group",8500.0,"$8500 per person | $17000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000.0,"$1000 per person | $2000 per group",0.3,1000.0,"$1000 per person | $2000 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",200.0,"$200 per person | $400 per group",0.5,200.0,"$200 per person | $400 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,375.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010035-01","Gold Elite Saver Plus HMO $1000 $10","Gold","Standard Gold On Exchange Plan",null,0.8043559182569029,"No","Yes","No",null,"Yes",0.44,0.56,1000.0,200.0,2700.0,0.0,200.0,1800.0,0.0,0.0,1000.0,200.0,300.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8500.0,"$8500 per person | $17000 per group",8500.0,"$8500 per person | $17000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000.0,"$1000 per person | $2000 per group",0.3,1000.0,"$1000 per person | $2000 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",200.0,"$200 per person | $400 per group",0.5,200.0,"$200 per person | $400 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,375.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010035-02","Gold AIAN HMO $0 $0","Gold","Zero Cost Sharing Plan Variation",null,1.0,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,"No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010035-03","Gold Elite Saver Plus HMO $1000 $10","Gold","Limited Cost Sharing Plan Variation",null,0.8043559182569029,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8500.0,"$8500 per person | $17000 per group",8500.0,"$8500 per person | $17000 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",1000.0,"$1000 per person | $2000 per group",0.3,1000.0,"$1000 per person | $2000 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",200.0,"$200 per person | $400 per group",0.5,200.0,"$200 per person | $400 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,375.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010051-00","Bronze Simple 2 HMO $9150 10%","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,9150.0,0.0,200.0,0.0,5300.0,80.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010051-01","Bronze Simple 2 HMO $9150 10%","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,9150.0,0.0,200.0,0.0,5300.0,80.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010051-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010051-03","Bronze Simple 2 HMO $9150 10%","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 3","index":5,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010065","Silver Classic Virtual Guided Care HMO $4000 $0","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Silver","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 3","index":6,"n_rows":10,"n_cols":419,"rows_kept":10,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010065-00","Silver Classic Virtual Guided Care HMO $4000 $0","Silver","Standard Silver Off Exchange Plan",null,0.7101170273913899,"Yes","Yes","No",null,"Yes",0.44,0.56,4000.0,200.0,2500.0,0.0,0.0,1600.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,4000.0,"$4000 per person | $8000 per group",0.4,4000.0,"$4000 per person | $8000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010065-01","Silver Classic Virtual Guided Care HMO $4000 $0","Silver","Standard Silver On Exchange Plan",null,0.7101170273913899,"Yes","Yes","No",null,"Yes",0.44,0.56,4000.0,200.0,2500.0,0.0,0.0,1600.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,4000.0,"$4000 per person | $8000 per group",0.4,4000.0,"$4000 per person | $8000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010065-02","Silver AIAN Guided Care HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010065-03","Silver Classic Virtual Guided Care HMO $4000 $0","Silver","Limited Cost Sharing Plan Variation",null,0.7101170273913899,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,4000.0,"$4000 per person | $8000 per group",0.4,4000.0,"$4000 per person | $8000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010065-04","Silver Classic Virtual Guided Care CSR 250 HMO $3000 $0","Silver","73% AV Level Silver Plan",null,0.7315712857705728,"Yes","Yes","No",null,"Yes",0.44,0.56,3000.0,200.0,2900.0,0.0,0.0,1600.0,0.0,0.0,2600.0,100.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7200.0,"$7200 per person | $14400 per group",7200.0,"$7200 per person | $14400 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,3000.0,"$3000 per person | $6000 per group",0.4,3000.0,"$3000 per person | $6000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010065-05","Silver Classic Virtual Guided Care CSR 200 HMO $1200 $0","Silver","87% AV Level Silver Plan",null,0.8721537041768073,"Yes","Yes","No",null,"Yes",0.44,0.56,1200.0,100.0,1400.0,0.0,0.0,1000.0,0.0,0.0,1200.0,50.0,400.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2700.0,"$2700 per person | $5400 per group",2700.0,"$2700 per person | $5400 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,1200.0,"$1200 per person | $2400 per group",0.3,1200.0,"$1200 per person | $2400 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,15.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010065-06","Silver Classic Virtual Guided Care CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.944917114292738,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,90.0,1200.0,0.0,0.0,700.0,0.0,0.0,0.0,20.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1250.0,"$1250 per person | $2500 per group",1250.0,"$1250 per person | $2500 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,0.0,"$0 per person | $0 per group",0.2,0.0,"$0 per person | $0 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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0]

{"sheet":"Benefits Package 4","index":7,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010005","Bronze Elite Saver Plus HMO $0 $50","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
[]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,"The per day copayment will apply for a maximum of two (2) days.",null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,"The per day copayment will apply for a maximum of two (2) days.",null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,"The per day copayment will apply for a maximum of two (2) days.",null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,"The per day copayment will apply for a maximum of two (2) days.",null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,"The per day copayment will apply for a maximum of two (2) days.",null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 4","index":8,"n_rows":7,"n_cols":419,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010005-00","Bronze Elite Saver Plus HMO $0 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6323539159085863,"No","Yes","No",null,"Yes",0.44,0.56,0.0,4200.0,0.0,0.0,4200.0,600.0,0.0,0.0,0.0,2100.0,100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10600.0,"$10600 per person | $21200 per group",10600.0,"$10600 per person | $21200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",7000.0,"$7000 per person | $14000 per group",0.5,7000.0,"$7000 per person | $14000 per group",0.5,"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,"Yes",null,null,null,2.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable",2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable","$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$125.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,750.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010005-01","Bronze Elite Saver Plus HMO $0 $50","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6323539159085863,"No","Yes","No",null,"Yes",0.44,0.56,0.0,4200.0,0.0,0.0,4200.0,600.0,0.0,0.0,0.0,2100.0,100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10600.0,"$10600 per person | $21200 per group",10600.0,"$10600 per person | $21200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",7000.0,"$7000 per person | $14000 per group",0.5,7000.0,"$7000 per person | $14000 per group",0.5,"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,"Yes",null,null,null,2.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable",2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable","$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$125.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,750.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010005-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,"Yes",null,null,null,2.0,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010005-03","Bronze Elite Saver Plus HMO $0 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6323539159085863,"No","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10600.0,"$10600 per person | $21200 per group",10600.0,"$10600 per person | $21200 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.5,0.0,"$0 per person | $0 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",7000.0,"$7000 per person | $14000 per group",0.5,7000.0,"$7000 per person | $14000 per group",0.5,"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,"Yes",null,null,null,2.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable",2500.0,"Not Applicable",2500.0,"Not Applicable","Not Applicable","Not Applicable","$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$3,000.00 Copay per Day","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$125.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,750.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,350.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,1200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,3000.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]

{"sheet":"Benefits Package 5","index":9,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010067","Bronze Simple Diabetes HMO $5500 $50","58081GA001","GAN001","GAS001","GAF001","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"First five (5) non-preventive visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Endocrinology, diabetic eye exams, and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 5","index":10,"n_rows":7,"n_cols":419,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010067-00","Bronze Simple Diabetes HMO $5500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",0.6417,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4200.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010067-01","Bronze Simple Diabetes HMO $5500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",0.6417,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4200.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010067-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010067-03","Bronze Simple Diabetes HMO $5500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",0.6417,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 6","index":11,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010069","Bronze Simple Breathe Easy with Enhanced COPD Benefits HMO $5500 $50","58081GA001","GAN001","GAS001","GAF001","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"First five (5) non-preventive visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Pulmonology office visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic antiasthmatics, and bronchodilators (inhalers) are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Pulmonary rehab visits are covered in full.",null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply. Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

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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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010069-00","Bronze Simple Breathe Easy with Enhanced COPD Benefits HMO $5500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",0.6416,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4300.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010069-01","Bronze Simple Breathe Easy with Enhanced COPD Benefits HMO $5500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",0.6416,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4300.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010069-02","Bronze AIAN HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010069-03","Bronze Simple Breathe Easy with Enhanced COPD Benefits HMO $5500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",0.6416,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 7","index":13,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010066","Bronze Simple MultiCondition Guided Care HMO $5500 $50","58081GA001","GAN002","GAS002","GAF001","New","HMO","Expanded Bronze","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"First five (5) non-preventive visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Qualified visits for cardiology, pulmonology, and endocrinology are covered in full. Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"First five (5) office visits combined between Outpatient Mental Health Services and Outpatient Chemical/Substance Use Disorder are covered in full. The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic statins, antiasthmatics, and bronchodilators (inhalers) are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Cardiac and pulmonary rehab visits are covered in full.",null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply. Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 7","index":14,"n_rows":7,"n_cols":419,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010066-00","Bronze Simple MultiCondition Guided Care HMO $5500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",0.6455,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4200.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010066-01","Bronze Simple MultiCondition Guided Care HMO $5500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",0.6455,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,200.0,2400.0,0.0,4200.0,600.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010066-02","Bronze AIAN Guided Care HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010066-03","Bronze Simple MultiCondition Guided Care HMO $5500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",0.6455,0.6403230943326994,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,5.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,200.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 8","index":15,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010045","Silver Simple Diabetes HMO $6500 $0","58081GA001","GAN001","GAS001","GAF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Endocrinology, diabetic eye exams, and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

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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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010045-00","Silver Simple Diabetes HMO $6500 $0","Silver","Standard Silver Off Exchange Plan",0.7003,0.6994479047578949,"Yes","Yes","No",null,"Yes",0.44,0.56,6500.0,200.0,1900.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,6500.0,"$6500 per person | $13000 per group",0.5,6500.0,"$6500 per person | $13000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010045-01","Silver Simple Diabetes HMO $6500 $0","Silver","Standard Silver On Exchange Plan",0.7003,0.6994479047578949,"Yes","Yes","No",null,"Yes",0.44,0.56,6500.0,200.0,1900.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,6500.0,"$6500 per person | $13000 per group",0.5,6500.0,"$6500 per person | $13000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010045-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010045-03","Silver Simple Diabetes HMO $6500 $0","Silver","Limited Cost Sharing Plan Variation",0.7003,0.6994479047578949,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,6500.0,"$6500 per person | $13000 per group",0.5,6500.0,"$6500 per person | $13000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010045-04","Silver Simple Diabetes CSR 250 HMO $4600 $0","Silver","73% AV Level Silver Plan",0.7363,0.7349390991901105,"Yes","Yes","No",null,"Yes",0.44,0.56,4600.0,200.0,2800.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8100.0,"$8100 per person | $16200 per group",8100.0,"$8100 per person | $16200 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,4600.0,"$4600 per person | $9200 per group",0.5,4600.0,"$4600 per person | $9200 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010045-05","Silver Simple Diabetes CSR 200 HMO $800 $0","Silver","87% AV Level Silver Plan",0.8726,0.8719338828807419,"Yes","Yes","No",null,"Yes",0.44,0.56,800.0,100.0,2400.0,0.0,0.0,1400.0,0.0,0.0,800.0,50.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3350.0,"$3350 per person | $6700 per group",3350.0,"$3350 per person | $6700 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,800.0,"$800 per person | $1600 per group",0.3,800.0,"$800 per person | $1600 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010045-06","Silver Simple Diabetes CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",0.9419,0.9416068981011267,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,40.0,1500.0,0.0,0.0,500.0,0.0,0.0,0.0,10.0,800.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1550.0,"$1550 per person | $3100 per group",1550.0,"$1550 per person | $3100 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,0.0,"$0 per person | $0 per group",0.3,0.0,"$0 per person | $0 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0]

{"sheet":"Benefits Package 9","index":17,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010068","Silver Simple Breathe Easy with Enhanced COPD Benefits HMO $6200 $0","58081GA001","GAN001","GAS001","GAF001","New","HMO","Silver","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
[]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Pulmonology office visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic antiasthmatics, and bronchodilators (inhalers) are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Pulmonary rehab visits are covered in full.",null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply. Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 9","index":18,"n_rows":10,"n_cols":419,"rows_kept":10,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010068-00","Silver Simple Breathe Easy with Enhanced COPD Benefits HMO $6200 $0","Silver","Standard Silver Off Exchange Plan",0.7177,0.7168262490102635,"Yes","Yes","No",null,"Yes",0.44,0.56,6200.0,200.0,2000.0,0.0,0.0,1800.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,6200.0,"$6200 per person | $12400 per group",0.5,6200.0,"$6200 per person | $12400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010068-01","Silver Simple Breathe Easy with Enhanced COPD Benefits HMO $6200 $0","Silver","Standard Silver On Exchange Plan",0.7177,0.7168262490102635,"Yes","Yes","No",null,"Yes",0.44,0.56,6200.0,200.0,2000.0,0.0,0.0,1800.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,6200.0,"$6200 per person | $12400 per group",0.5,6200.0,"$6200 per person | $12400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010068-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010068-03","Silver Simple Breathe Easy with Enhanced COPD Benefits HMO $6200 $0","Silver","Limited Cost Sharing Plan Variation",0.7177,0.7168262490102635,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,6200.0,"$6200 per person | $12400 per group",0.5,6200.0,"$6200 per person | $12400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010068-04","Silver Simple Breathe Easy with Enhanced COPD Benefits CSR 250 HMO $5200 $0","Silver","73% AV Level Silver Plan",0.7386,0.737650353118617,"Yes","Yes","No",null,"Yes",0.44,0.56,5200.0,200.0,2500.0,0.0,0.0,1800.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8100.0,"$8100 per person | $16200 per group",8100.0,"$8100 per person | $16200 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,5200.0,"$5200 per person | $10400 per group",0.5,5200.0,"$5200 per person | $10400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010068-05","Silver Simple Breathe Easy with Enhanced COPD Benefits CSR 200 HMO $900 $0","Silver","87% AV Level Silver Plan",0.88,0.8794777197847634,"Yes","Yes","No",null,"Yes",0.44,0.56,900.0,100.0,1900.0,0.0,0.0,1100.0,0.0,0.0,900.0,50.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2900.0,"$2900 per person | $5800 per group",2900.0,"$2900 per person | $5800 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,900.0,"$900 per person | $1800 per group",0.3,900.0,"$900 per person | $1800 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,6.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010068-06","Silver Simple Breathe Easy with Enhanced COPD Benefits CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",0.9438,0.9436274295544756,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,40.0,1400.0,0.0,0.0,600.0,0.0,0.0,0.0,10.0,800.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1450.0,"$1450 per person | $2900 per group",1450.0,"$1450 per person | $2900 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,0.0,"$0 per person | $0 per group",0.3,0.0,"$0 per person | $0 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0]

{"sheet":"Benefits Package 10","index":19,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010087","Silver Simple Women's Health with Menopause Benefits HMO $6000 $0","58081GA001","GAN001","GAS001","GAF001","New","HMO","Silver","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Gynecologist office visits are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic hormone replacement therapy and SSRIs are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"DEXA bone density scans, comprehensive metabolic panel, and lab testing for bone health are covered in full",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,"DEXA bone density scans, comprehensive metabolic panel, and lab testing for bone health are covered in full",null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 10","index":20,"n_rows":10,"n_cols":419,"rows_kept":10,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010087-00","Silver Simple Women's Health with Menopause Benefits HMO $6000 $0","Silver","Standard Silver Off Exchange Plan",0.7096,0.7006469374303699,"Yes","Yes","No",null,"Yes",0.44,0.56,6000.0,100.0,2100.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,6000.0,"$6000 per person | $12000 per group",0.5,6000.0,"$6000 per person | $12000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010087-01","Silver Simple Women's Health with Menopause Benefits HMO $6000 $0","Silver","Standard Silver On Exchange Plan",0.7096,0.7006469374303699,"Yes","Yes","No",null,"Yes",0.44,0.56,6000.0,100.0,2100.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,6000.0,"$6000 per person | $12000 per group",0.5,6000.0,"$6000 per person | $12000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010087-02","Silver AIAN HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010087-03","Silver Simple Women's Health with Menopause Benefits HMO $6000 $0","Silver","Limited Cost Sharing Plan Variation",0.7096,0.7006469374303699,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,6000.0,"$6000 per person | $12000 per group",0.5,6000.0,"$6000 per person | $12000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010087-04","Silver Simple Women's Health with Menopause Benefits CSR 250 HMO $5500 $0","Silver","73% AV Level Silver Plan",0.737,0.7299968320285347,"Yes","Yes","No",null,"Yes",0.44,0.56,5500.0,100.0,2400.0,0.0,4200.0,200.0,0.0,0.0,2600.0,80.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8100.0,"$8100 per person | $16200 per group",8100.0,"$8100 per person | $16200 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,5500.0,"$5500 per person | $11000 per group",0.5,5500.0,"$5500 per person | $11000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010087-05","Silver Simple Women's Health with Menopause Benefits CSR 200 HMO $870 $0","Silver","87% AV Level Silver Plan",0.8735,0.8694821423855513,"Yes","Yes","No",null,"Yes",0.44,0.56,870.0,100.0,2400.0,0.0,0.0,1500.0,0.0,0.0,870.0,50.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3350.0,"$3350 per person | $6700 per group",3350.0,"$3350 per person | $6700 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,870.0,"$870 per person | $1740 per group",0.3,870.0,"$870 per person | $1740 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010087-06","Silver Simple Women's Health with Menopause Benefits CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",0.9428,0.9416068981011267,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,40.0,1500.0,0.0,0.0,500.0,0.0,0.0,0.0,10.0,800.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1550.0,"$1550 per person | $3100 per group",1550.0,"$1550 per person | $3100 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,0.0,"$0 per person | $0 per group",0.3,0.0,"$0 per person | $0 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0]

{"sheet":"Benefits Package 11","index":21,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010064","Silver Simple MultiCondition Guided Care HMO $5900 $0","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Silver","Not Applicable","Yes","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Qualified visits for cardiology, pulmonology, and endocrinology are covered in full. Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic statins, antiasthmatics, and bronchodilators (inhalers) are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Cardiac and pulmonary rehab visits are covered in full.",null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply. Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 11","index":22,"n_rows":10,"n_cols":419,"rows_kept":10,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010064-00","Silver Simple MultiCondition Guided Care HMO $5900 $0","Silver","Standard Silver Off Exchange Plan",0.708,0.7009863222439321,"Yes","Yes","No",null,"Yes",0.44,0.56,5900.0,200.0,2200.0,0.0,4200.0,200.0,0.0,0.0,2600.0,70.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5900.0,"$5900 per person | $11800 per group",0.5,5900.0,"$5900 per person | $11800 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010064-01","Silver Simple MultiCondition Guided Care HMO $5900 $0","Silver","Standard Silver On Exchange Plan",0.708,0.7009863222439321,"Yes","Yes","No",null,"Yes",0.44,0.56,5900.0,200.0,2200.0,0.0,4200.0,200.0,0.0,0.0,2600.0,70.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5900.0,"$5900 per person | $11800 per group",0.5,5900.0,"$5900 per person | $11800 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010064-02","Silver AIAN Guided Care HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",1.0,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010064-03","Silver Simple MultiCondition Guided Care HMO $5900 $0","Silver","Limited Cost Sharing Plan Variation",0.708,0.7009863222439321,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,5900.0,"$5900 per person | $11800 per group",0.5,5900.0,"$5900 per person | $11800 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,65.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010064-04","Silver Simple MultiCondition Guided Care CSR 250 HMO $5000 $0","Silver","73% AV Level Silver Plan",0.7398,0.7326552867944358,"Yes","Yes","No",null,"Yes",0.44,0.56,5000.0,200.0,2600.0,0.0,4200.0,200.0,0.0,0.0,2600.0,70.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8100.0,"$8100 per person | $16200 per group",8100.0,"$8100 per person | $16200 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,5000.0,"$5000 per person | $10000 per group",0.5,5000.0,"$5000 per person | $10000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010064-05","Silver Simple MultiCondition Guided Care CSR 200 HMO $800 $0","Silver","87% AV Level Silver Plan",0.8745,0.8719338828807419,"Yes","Yes","No",null,"Yes",0.44,0.56,800.0,100.0,2400.0,0.0,0.0,1400.0,0.0,0.0,800.0,50.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3350.0,"$3350 per person | $6700 per group",3350.0,"$3350 per person | $6700 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,800.0,"$800 per person | $1600 per group",0.3,800.0,"$800 per person | $1600 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010064-06","Silver Simple MultiCondition Guided Care CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",0.9436,0.9426844127682543,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,40.0,1500.0,0.0,0.0,500.0,0.0,0.0,0.0,10.0,800.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1500.0,"$1500 per person | $3000 per group",1500.0,"$1500 per person | $3000 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,0.0,"$0 per person | $0 per group",0.3,0.0,"$0 per person | $0 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",0.3,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,5.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.3,"Not Applicable",1.0]

{"sheet":"Benefits Package 12","index":23,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010070","Bronze HMO $3000 $75 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010074","Silver HMO $3000 $60 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Silver","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010076","Buena Salud Plateado HMO $3500 $40 (fuera del mercado)","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Silver","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010084","Gold HMO $2000 $30 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Gold","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 12","index":24,"n_rows":7,"n_cols":419,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010070-00","Bronze HMO $3000 $75 Off Exchange","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6432797569213076,"No","Yes","No",null,"Yes",0.44,0.56,3000.0,60.0,2900.0,0.0,3000.0,700.0,600.0,0.0,2200.0,400.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",3000.0,"$3000 per person | $6000 per group",0.4,3000.0,"$3000 per person | $6000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",3000.0,"$3000 per person | $6000 per group",0.5,3000.0,"$3000 per person | $6000 per group",0.5,"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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,4.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010074-00","Silver HMO $3000 $60 Off Exchange","Silver","Standard Silver Off Exchange Plan",null,0.6960173870208837,"Yes","Yes","No",null,"Yes",0.44,0.56,3000.0,90.0,1800.0,0.0,0.0,2500.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,3000.0,"$3000 per person | $6000 per group",0.25,3000.0,"$3000 per person | $6000 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,95.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","25.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,4.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,95.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","25.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010076-00","Buena Salud Plateado HMO $3500 $40 (fuera del mercado)","Silver","Standard Silver Off Exchange Plan",null,0.7051250407824351,"Yes","Yes","No",null,"Yes",0.44,0.56,3500.0,60.0,2400.0,0.0,0.0,2400.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,3500.0,"$3500 per person | $7000 per group",0.35,3500.0,"$3500 per person | $7000 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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","35.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,4.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$300.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","35.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010084-00","Gold HMO $2000 $30 Off Exchange","Gold","Standard Gold Off Exchange Plan",null,0.7835438749468877,"Yes","Yes","No",null,"Yes",0.44,0.56,2000.0,0.0,1800.0,0.0,0.0,1900.0,20.0,0.0,2000.0,100.0,100.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8500.0,"$8500 per person | $17000 per group",8500.0,"$8500 per person | $17000 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,2000.0,"$2000 per person | $4000 per group",0.2,2000.0,"$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","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,null,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","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","Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,4.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","20.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 13","index":25,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010077","Silver MultiCondition Care HMO $3750 $30 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Silver","Not Applicable","Yes","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers. Virtual primary care services provided by Oscar-designated virtual care providers are covered in full. Virtual pediatric primary care services are not available through Oscar Medical Group; these services should be obtained in-person from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Qualified visits for cardiology, pulmonology, and endocrinology are covered in full. Diabetic eye exams and diabetic foot exams are covered in full. Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.","Common prescription generic statins, antiasthmatics, and bronchodilators (inhalers) are covered in full.",null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Cardiac and pulmonary rehab visits are covered in full.",null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Oxygen is covered in full for members with COPD and other medical conditions that can be treated with long-term supportive oxygen therapy. Prior authorization for medical necessity may apply. Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,"Labs (HbA1c screening, urinalysis, metabolic panel, lipid panel) are covered in full.",null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 13","index":26,"n_rows":4,"n_cols":419,"rows_kept":4,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010077-00","Silver MultiCondition Care HMO $3750 $30 Off Exchange","Silver","Standard Silver Off Exchange Plan",0.7054,0.7008423447503693,"Yes","Yes","No",null,"Yes",0.44,0.56,3750.0,90.0,2600.0,0.0,0.0,2400.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9500.0,"$9500 per person | $19000 per group",9500.0,"$9500 per person | $19000 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,3750.0,"$3750 per person | $7500 per group",0.4,3750.0,"$3750 per person | $7500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,95.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"$750.00 Copay after deductible","Not Applicable","$750.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,4.0,35.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$150.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,35.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,25.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,95.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]

{"sheet":"Benefits Package 14","index":27,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010073","Bronze HSA HMO $8300 $0 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010079","Silver HSA HMO $6000 $0 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Silver","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010085","Gold HSA HMO $3750 $0 Off Exchange","58081GA001","GAN001","GAS003","GAF001","Existing","HMO","Gold","Not Applicable","No","Off the Exchange","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full once the deductible has been met. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 14","index":28,"n_rows":6,"n_cols":419,"rows_kept":6,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010073-00","Bronze HSA HMO $8300 $0 Off Exchange","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.625176648067309,"Yes","Yes","No",null,"No",1.0,null,8300.0,0.0,0.0,0.0,5400.0,0.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,8300.0,"$8300 per person | $16600 per group",0.0,8300.0,"$8300 per person | $16600 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010079-00","Silver HSA HMO $6000 $0 Off Exchange","Silver","Standard Silver Off Exchange Plan",null,0.6802147621970877,"Yes","Yes","No",null,"Yes",0.44,0.56,6000.0,0.0,0.0,0.0,5400.0,0.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,6000.0,"$6000 per person | $12000 per group",0.0,6000.0,"$6000 per person | $12000 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$4.00 Copay after deductible","$10.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$145.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010085-00","Gold HSA HMO $3750 $0 Off Exchange","Gold","Standard Gold Off Exchange Plan",null,0.7819351889379883,"Yes","Yes","No",null,"Yes",0.44,0.56,3750.0,0.0,0.0,0.0,3750.0,400.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8300.0,"$8300 per person | $16600 per group",8300.0,"$8300 per person | $16600 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,3750.0,"$3750 per person | $7500 per group",0.0,3750.0,"$3750 per person | $7500 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay after deductible","Not Applicable","$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay per Stay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$4.00 Copay after deductible","$10.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable",1.0,"$35.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$75.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","0.00% Coinsurance after deductible","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$0.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]

{"sheet":"Benefits Package 15","index":29,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":false,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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*",58081.0,null,"You will need to save the latest version of the add-in file (PlansBenefitsAddInPY26.xlam) on your machine."]
["Issuer State*","GA",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*","Individual",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*"]
["58081GA0010056","Bronze Classic Standard Guided Care HMO $7500 $50","58081GA001","GAN002","GAS002","GAF002","Existing","HMO","Expanded Bronze","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010057","Silver Classic Standard Guided Care HMO $6000 $40","58081GA001","GAN002","GAS002","GAF004","Existing","HMO","Silver","Design 1","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010060","Bronze Classic 4700 Guided Care HMO $4700 $70","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010061","Bronze Classic Saver Plus Guided Care HMO $8000 $0","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010062","Bronze Simple 2 Guided Care HMO $9150 10%","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Expanded Bronze","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
["58081GA0010063","Silver Simple Saver Guided Care HMO $5750 $10","58081GA001","GAN002","GAS002","GAF001","Existing","HMO","Silver","Not Applicable","No","Both","No",null,0.0,"No","Allows Adult and Child-Only",null,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",1.0,null,null,"2026-01-01","2026-12-31","Yes","Emergency Services Only","Yes","Emergency and Urgent Services Only","No"]
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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",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Specialist Visit",null,"Yes","Covered",null,null,null,null,"Cost share applies to both in-person and telemedicine services from in-network providers.",null,"No","Yes"]
["Other Practitioner Office Visit (Nurse, Physician Assistant)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Facility Fee (e.g., Ambulatory Surgery Center)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Outpatient Surgery Physician/Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Hospice Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Routine Dental Services (Adult)",null,null,"Not Covered"]
["Infertility Treatment",null,null,"Covered",null,null,null,null,null,"Other Law/Regulation","No","Yes"]
["Long-Term/Custodial Nursing Home Care",null,null,"Not Covered"]
["Private-Duty Nursing",null,null,"Not Covered"]
["Routine Eye Exam (Adult)",null,null,"Not Covered"]
["Urgent Care Centers or Facilities",null,"Yes","Covered",null,null,null,null,"Virtual urgent care services provided by Oscar-designated virtual care providers are covered in full. When temporarily out of the Service Area, Out-of-Network Urgent Care services are covered. In addition to applicable cost share, you may be responsible for balance billing.",null,"No","Yes"]
["Home Health Care Services",null,"Yes","Covered","Yes",120.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Emergency Room Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Emergency Transportation/Ambulance",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Hospital Services (e.g., Hospital Stay)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Inpatient Physician and Surgical Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Bariatric Surgery",null,null,"Not Covered"]
["Cosmetic Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Skilled Nursing Facility",null,"Yes","Covered","Yes",60.0,"Days per Year",null,null,null,"No","Yes"]
["Prenatal and Postnatal Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Delivery and All Inpatient Services for Maternity Care",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Mental/Behavioral Health Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Mental/Behavioral Health Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Substance Abuse Disorder Outpatient Services",null,"Yes","Covered",null,null,null,null,"The cost sharing that displays applies to outpatient office visits only. All other outpatient services, such as Partial Hospitalization and Intensive Outpatient Program, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.",null,"No","Yes"]
["Substance Abuse Disorder Inpatient Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Generic Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Non-Preferred Brand Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Specialty Drugs",null,"Yes","Covered",null,null,null,"Excludes infertility services including medications.",null,null,"No","Yes"]
["Outpatient Rehabilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Habilitation Services",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Habilitative services apply toward the \"Physical medicine and rehabilitative services\" maximum number of visits specified in the \"Schedule of Benefits.\"",null,"No","Yes"]
["Chiropractic Care",null,null,"Covered",null,null,null,null,null,"Not EHB - Defrayed to Issuer","No","Yes"]
["Durable Medical Equipment",null,"Yes","Covered",null,null,null,null,"Hearing aids, the fitting of hearing aids or advice on their care; implantable hearing devices are not covered, except for cochlear implants as otherwise stated in this certificate.",null,"No","Yes"]
["Hearing Aids",null,null,"Not Covered"]
["Imaging (CT/PET Scans, MRIs)",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Preventive Care/Screening/Immunization",null,"Yes","Covered",null,null,null,null,"The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). Well Woman and Well Man exams are limited to one (1) visit per Benefit Period.",null,"No","Yes"]
["Routine Foot Care",null,null,"Not Covered"]
["Acupuncture",null,null,"Not Covered"]
["Weight Loss Programs",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,"Nutritional counseling for the treatment of obesity, which includes morbid obesity.",null,"No","Yes"]
["Routine Eye Exam for Children",null,"Yes","Covered","Yes",1.0,"Exam(s) per Year",null,null,null,"No","Yes"]
["Eye Glasses for Children",null,"Yes","Covered","Yes",1.0,"Item(s) per Year",null,null,null,"No","Yes"]
["Dental Check-Up for Children",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Rehabilitative Speech Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Rehabilitative Occupational and Rehabilitative Physical Therapy",null,"Yes","Covered","Yes",40.0,"Visit(s) per Year",null,"Visits are combined for physical therapy, occupational therapy, spinal manipulation, speech therapy or speech pathology services, and audiology services.",null,"No","Yes"]
["Well Baby Visits and Care",null,"Yes","Covered",null,null,null,null,"Care provided for birth through age 5.",null,"No","Yes"]
["Laboratory Outpatient and Professional Services",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["X-rays and Diagnostic Imaging",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Basic Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Orthodontia – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["Major Dental Care – Child",null,"Yes","Not Covered",null,null,null,null,null,"Dental Only Plan Available"]
["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,"Not Covered"]
["Transplant",null,"Yes","Covered","Yes",10000.0,"Dollars per Procedure",null,"Limited to a combined maximum of $10,000 per covered organ transplant.",null,"No","Yes"]
["Accidental Dental",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Dialysis",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Allergy Testing",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Chemotherapy",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Radiation",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Diabetes Education",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Prosthetic Devices",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Infusion Therapy",null,"Yes","Covered",null,null,null,null,"Insulin infusion devices.",null,"No","Yes"]
["Treatment for Temporomandibular Joint Disorders",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]
["Nutritional Counseling",null,"Yes","Covered","Yes",4.0,"Visit(s) per Year",null,null,null,"No","Yes"]
["Reconstructive Surgery",null,"Yes","Covered",null,null,null,null,null,null,"No","Yes"]

{"sheet":"Cost Share Variances 15","index":30,"n_rows":33,"n_cols":419,"rows_kept":33,"cut":false,"hidden":false,"merged":[[0,377,0,382],[0,383,0,388],[0,389,0,394],[0,395,0,400],[0,401,0,406],[0,407,0,412],[0,413,0,418],[0,335,0,340],[0,341,0,346],[0,347,0,352],[0,353,0,358],[0,359,0,364],[0,365,0,370],[0,371,0,376],[0,79,0,81],[0,82,0,85],[0,89,0,96],[0,97,0,104],[0,105,0,112],[0,113,0,118],[0,119,0,124],[0,125,0,130],[0,131,0,136],[0,137,0,142],[0,143,0,148],[0,149,0,154],[0,155,0,160],[0,161,0,166],[0,167,0,172],[0,173,0,178],[0,179,0,184],[0,185,0,190],[0,191,0,196],[0,197,0,202],[0,203,0,208],[0,209,0,214],[0,215,0,220],[0,221,0,226],[0,227,0,232],[0,233,0,238],[0,239,0,244],[0,245,0,250],[0,251,0,256],[0,257,0,262],[0,263,0,268],[0,269,0,274],[0,275,0,280],[0,281,0,286],[0,287,0,292],[0,293,0,298],[0,299,0,304],[0,305,0,310],[0,311,0,316],[0,317,0,322],[0,323,0,328],[0,329,0,334],[0,13,0,24],[0,25,0,32],[0,33,0,40],[0,41,0,48],[0,49,0,58],[0,59,0,68],[0,69,0,78],[1,0,1,12],[1,13,1,16],[1,17,1,20],[1,21,1,24],[1,25,1,26],[1,27,1,28],[1,29,1,30],[1,31,1,32],[1,33,1,34],[1,35,1,36],[1,37,1,38],[1,39,1,40],[1,41,1,42],[1,43,1,44],[1,45,1,46],[1,47,1,48],[1,49,1,51],[1,52,1,54],[1,55,1,56],[1,57,1,58],[1,59,1,61],[1,62,1,64],[1,65,1,66],[1,67,1,68],[1,69,1,71],[1,72,1,74],[1,75,1,76],[1,77,1,78],[1,79,1,81],[1,87,1,88],[1,89,1,90],[1,91,1,92],[1,93,1,94],[1,95,1,96],[1,97,1,98],[1,99,1,100],[1,101,1,102],[1,103,1,104],[1,105,1,106],[1,107,1,108],[1,109,1,110],[1,111,1,112],[1,113,1,115],[1,116,1,118],[1,119,1,121],[1,122,1,124],[1,125,1,127],[1,128,1,130],[1,131,1,133],[1,281,1,283],[1,284,1,286],[1,287,1,289],[1,290,1,292],[1,293,1,295],[1,296,1,298],[1,299,1,301],[1,302,1,304],[1,305,1,307],[1,308,1,310],[1,311,1,313],[1,314,1,316],[1,317,1,319],[1,320,1,322],[1,323,1,325],[1,326,1,328],[1,329,1,331],[1,332,1,334],[1,335,1,337],[1,338,1,340],[1,341,1,343],[1,344,1,346],[1,347,1,349],[1,350,1,352],[1,353,1,355],[1,356,1,358],[1,359,1,361],[1,362,1,364],[1,365,1,367],[1,368,1,370],[1,371,1,373],[1,374,1,376],[1,377,1,379],[1,380,1,382],[1,383,1,385],[1,407,1,409],[1,410,1,412],[1,413,1,415],[1,416,1,418],[1,386,1,388],[1,389,1,391],[1,392,1,394],[1,395,1,397],[1,398,1,400],[1,401,1,403],[1,404,1,406],[1,134,1,136],[1,137,1,139],[1,140,1,142],[1,143,1,145],[1,146,1,148],[1,149,1,151],[1,152,1,154],[1,155,1,157],[1,158,1,160],[1,161,1,163],[1,164,1,166],[1,167,1,169],[1,170,1,172],[1,173,1,175],[1,176,1,178],[1,179,1,181],[1,182,1,184],[1,185,1,187],[1,188,1,190],[1,191,1,193],[1,194,1,196],[1,197,1,199],[1,200,1,202],[1,203,1,205],[1,206,1,208],[1,209,1,211],[1,212,1,214],[1,215,1,217],[1,218,1,220],[1,221,1,223],[1,224,1,226],[1,227,1,229],[1,230,1,232],[1,233,1,235],[1,236,1,238],[1,239,1,241],[1,242,1,244],[1,245,1,247],[1,248,1,250],[1,251,1,253],[1,254,1,256],[1,257,1,259],[1,260,1,262],[1,263,1,265],[1,266,1,268],[1,269,1,271],[1,272,1,274],[1,275,1,277],[1,278,1,280]]}
["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,"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,"Cosmetic 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,"Imaging (CT/PET Scans, MRIs)",null,null,null,null,null,"Preventive Care/Screening/Immunization",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,"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,"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"]
["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"]
["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"]
["58081GA0010056-00","Bronze Classic Standard Guided Care HMO $7500 $50","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010056-01","Bronze Classic Standard Guided Care HMO $7500 $50","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,7500.0,20.0,1800.0,0.0,4300.0,500.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010056-02","Bronze AIAN Guided Care HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010056-03","Bronze Classic Standard Guided Care HMO $7500 $50","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.641164682729525,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10000.0,"$10000 per person | $20000 per group",10000.0,"$10000 per person | $20000 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,7500.0,"$7500 per person | $15000 per group",0.5,7500.0,"$7500 per person | $15000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,25.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$50.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$100.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$500.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-00","Silver Classic Standard Guided Care HMO $6000 $40","Silver","Standard Silver Off Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-01","Silver Classic Standard Guided Care HMO $6000 $40","Silver","Standard Silver On Exchange Plan",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,6000.0,20.0,2100.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-02","Silver AIAN Guided Care HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010057-03","Silver Classic Standard Guided Care HMO $6000 $40","Silver","Limited Cost Sharing Plan Variation",null,0.700079494788872,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8900.0,"$8900 per person | $17800 per group",8900.0,"$8900 per person | $17800 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,6000.0,"$6000 per person | $12000 per group",0.4,6000.0,"$6000 per person | $12000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-04","Silver Classic Standard Guided Care CSR 250 HMO $3000 $40","Silver","73% AV Level Silver Plan",null,0.730702360935441,"Yes","Yes","No",null,"No",1.0,null,3000.0,20.0,3300.0,0.0,100.0,1400.0,0.0,0.0,2200.0,300.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7400.0,"$7400 per person | $14800 per group",7400.0,"$7400 per person | $14800 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,3000.0,"$3000 per person | $6000 per group",0.4,3000.0,"$3000 per person | $6000 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,60.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,20.0,20.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$80.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$350.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-05","Silver Classic Standard Guided Care CSR 200 HMO $700 $20","Silver","87% AV Level Silver Plan",null,0.870442632272473,"Yes","Yes","No",null,"No",1.0,null,700.0,0.0,2600.0,0.0,100.0,900.0,0.0,0.0,700.0,100.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3300.0,"$3300 per person | $6600 per group",3300.0,"$3300 per person | $6600 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,700.0,"$700 per person | $1400 per group",0.3,700.0,"$700 per person | $1400 per group",0.3,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","30.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,10.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$60.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"$250.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0,20.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","30.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010057-06","Silver Classic Standard Guided Care CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.941107499644086,"Yes","Yes","No",null,"No",1.0,null,0.0,0.0,2200.0,0.0,0.0,500.0,30.0,0.0,0.0,20.0,600.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2200.0,"$2200 per person | $4400 per group",2200.0,"$2200 per person | $4400 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,0.0,"$0 per person | $0 per group",0.25,0.0,"$0 per person | $0 per group",0.25,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,5.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",0.25,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,15.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,150.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.25,"Not Applicable",1.0]
["58081GA0010060-00","Bronze Classic 4700 Guided Care HMO $4700 $70","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,4700.0,200.0,2800.0,0.0,4200.0,700.0,0.0,0.0,2200.0,500.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010060-01","Bronze Classic 4700 Guided Care HMO $4700 $70","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,4700.0,200.0,2800.0,0.0,4200.0,700.0,0.0,0.0,2200.0,500.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010060-02","Bronze AIAN Guided Care HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010060-03","Bronze Classic 4700 Guided Care HMO $4700 $70","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6400686956922621,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9600.0,"$9600 per person | $19200 per group",9600.0,"$9600 per person | $19200 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,4700.0,"$4700 per person | $9400 per group",0.5,4700.0,"$4700 per person | $9400 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,125.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,70.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010061-00","Bronze Classic Saver Plus Guided Care HMO $8000 $0","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,8000.0,200.0,1100.0,0.0,4500.0,200.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010061-01","Bronze Classic Saver Plus Guided Care HMO $8000 $0","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,8000.0,200.0,1100.0,0.0,4500.0,200.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010061-02","Bronze AIAN Guided Care HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010061-03","Bronze Classic Saver Plus Guided Care HMO $8000 $0","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6251192370425674,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,8000.0,"$8000 per person | $16000 per group",0.5,8000.0,"$8000 per person | $16000 per group",0.5,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","50.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,3.0,30.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"$200.00 Copay after deductible","Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010062-00","Bronze Simple 2 Guided Care HMO $9150 10%","Expanded Bronze","Standard Bronze Off Exchange Plan",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,9150.0,0.0,200.0,0.0,5400.0,0.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010062-01","Bronze Simple 2 Guided Care HMO $9150 10%","Expanded Bronze","Standard Bronze On Exchange Plan",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,9150.0,0.0,200.0,0.0,5400.0,0.0,0.0,0.0,2800.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010062-02","Bronze AIAN Guided Care HMO $0 $0","Expanded Bronze","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010062-03","Bronze Simple 2 Guided Care HMO $9150 10%","Expanded Bronze","Limited Cost Sharing Plan Variation",null,0.6039721203587342,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10150.0,"$10150 per person | $20300 per group",10150.0,"$10150 per person | $20300 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,9150.0,"$9150 per person | $18300 per group",0.1,9150.0,"$9150 per person | $18300 per group",0.1,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","Yes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","10.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","10.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-00","Silver Simple Saver Guided Care HMO $5750 $10","Silver","Standard Silver Off Exchange Plan",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,5750.0,0.0,2200.0,0.0,100.0,2200.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-01","Silver Simple Saver Guided Care HMO $5750 $10","Silver","Standard Silver On Exchange Plan",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,5750.0,0.0,2200.0,0.0,100.0,2200.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-02","Silver AIAN Guided Care HMO $0 $0","Silver","Zero Cost Sharing Plan Variation",null,1.0,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,"$0 per person | $0 per group","Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable",0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,null,null,null,null,0.0,"$0 per person | $0 per group",0.0,0.0,"$0 per person | $0 per group",0.0,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","No",null,null,null,null,null,null,null,null,null,0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"$0 per person | $0 per group\n",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,0.0,"Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0]
["58081GA0010063-03","Silver Simple Saver Guided Care HMO $5750 $10","Silver","Limited Cost Sharing Plan Variation",null,0.7003205777703363,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,9900.0,"$9900 per person | $19800 per group",9900.0,"$9900 per person | $19800 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,5750.0,"$5750 per person | $11500 per group",0.4,5750.0,"$5750 per person | $11500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,100.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-04","Silver Simple Saver Guided Care CSR 250 HMO $4750 $10","Silver","73% AV Level Silver Plan",null,0.7306718224942512,"Yes","Yes","No",null,"Yes",0.44,0.56,4750.0,0.0,2600.0,0.0,100.0,1900.0,0.0,0.0,2600.0,200.0,0.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,7780.0,"$7780 per person | $15560 per group",7780.0,"$7780 per person | $15560 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,4750.0,"$4750 per person | $9500 per group",0.4,4750.0,"$4750 per person | $9500 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,75.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,25.0,"Not Applicable","Not Applicable","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,80.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-05","Silver Simple Saver Guided Care CSR 200 HMO $800 $10","Silver","87% AV Level Silver Plan",null,0.8702603722057195,"Yes","Yes","No",null,"Yes",0.44,0.56,800.0,0.0,2700.0,0.0,100.0,1200.0,0.0,0.0,800.0,90.0,700.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3100.0,"$3100 per person | $6200 per group",3100.0,"$3100 per person | $6200 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,800.0,"$800 per person | $1600 per group",0.4,800.0,"$800 per person | $1600 per group",0.4,"Not Applicable","per person not applicable | per group not applicable","Not Applicable","per person not applicable | per group not applicable","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,null,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,50.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","40.00% Coinsurance after deductible","Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,3.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,40.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","50.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,45.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable","40.00% Coinsurance after deductible","Not Applicable",1.0]
["58081GA0010063-06","Silver Simple Saver Guided Care CSR 150 HMO $0 $0","Silver","94% AV Level Silver Plan",null,0.9401873680893513,"Yes","Yes","No",null,"Yes",0.44,0.56,0.0,0.0,2200.0,0.0,0.0,800.0,20.0,0.0,0.0,20.0,500.0,0.0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2100.0,"$2100 per person | $4200 per group",2100.0,"$2100 per person | $4200 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,0.0,"$0 per person | $0 per group",0.2,0.0,"$0 per person | $0 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",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",0.2,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,10.0,"Not Applicable","Not Applicable","Not Applicable",1.0,30.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.5,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.0,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,10.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0,0.0,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",1.0,"Not Applicable","Not Applicable","Not Applicable",0.2,"Not Applicable",1.0]

{"sheet":"DefaultBP","index":31,"n_rows":126,"n_cols":30,"rows_kept":126,"cut":false,"hidden":true,"merged":[[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],[108,0,108,1],[109,0,109,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[120,0,120,1],[121,0,121,1],[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[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],[5,0,5,5],[5,6,5,20],[5,21,5,22],[5,23,5,24],[5,25,5,29],[57,3,57,9],[57,10,57,11],[57,0,57,2],[58,0,58,1],[59,0,59,1],[60,0,60,1],[61,0,61,1],[62,0,62,1],[63,0,63,1],[64,0,64,1],[65,0,65,1],[66,0,66,1],[67,0,67,1],[68,0,68,1],[69,0,69,1],[70,0,70,1],[71,0,71,1],[72,0,72,1],[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],[84,0,84,1],[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],[96,0,96,1],[97,0,97,1],[98,0,98,1]]}
["2026 Plans & Benefits Template v15.0 [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 (PlansBenefitsAddInPY26.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"]

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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 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["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",true,false]
[null,"AR",null,"Applied Behavior Analysis Based Therapies",null,"Sheet6",true,false]
["Bronze","AZ",null,"Attention Deficit Disorder",null,"Sheet21",true,false]
["Expanded Bronze","CA",null,"Autism Spectrum Disorders",null,"Sheet22",true,false]
["Silver","CO",null,"Blood and Blood Services",null,"Sheet23",true,false]
["Gold","CT",null,"Bone Marrow Testing",null,"Sheet24",true,false]
["Platinum","DC",null,"Bone Marrow Transplant",null,"Sheet25",true,false]
["Catastrophic","DE",null,"Bone Marrow Transplants for Treatment of Breast Cancer",null,"Sheet26",true,false]
[null,"FL",null,"Bones/Joints",null,"Sheet27",true,false]
["Yes","GA",null,"Brain Injury",null,"Sheet28",true,false]
["No","HI",null,"Breast Implant Removal",null,"Sheet29",true,false]
[null,"IA",null,"Breast Reconstructive Surgery",null,"Sheet30",true,false]
["Indemnity","ID",null,"Cancer Treatments",null,"Sheet31",true,false]
["PPO","IL",null,"Cardiac Rehabilitation",null,"Sheet32",true,false]
["HMO","IN",null,"Clinical Trials",null,"Sheet34",true,false]
["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"]
["$X","NJ",null,"Heart Transplant"]
["Not Applicable","NM",null,"Hormone Replacement Therapy (HRT)"]
[null,"NV",null,"Human Leukocyte Antigen Testing"]
["On the Exchange","NY",null,"Hypodermic Syringes or Needles "]
["Off the Exchange","OH",null,"Infant Formulas"]
["Both","OK",null,"Inherited Metabolic Disorder - PKU"]
[null,"OR",null,"Mental Health Other"]
["Covered","PA",null,"Mental Health Parity"]
["Not Covered","RI",null,"Morbid Obesity Treatment"]
[null,"SC",null,"Multiple Sclerosis "]
["Standard Plan","SD",null,"Network Retail Pharmacy (60-90 Day Supply) Covered"]
["73% AV CSR Silver Plan Variation","TN",null,"Newborn Hearing Screening"]
["87% AV CSR Silver Plan Variation","TX",null,"Newborn Services Other"]
["94% AV CSR Silver Plan Variation","UT",null,"Nutrition/Formulas"]
["Zero Cost Sharing Plan Variation","VA",null,"Off Label Prescription Drugs"]
["Limited Cost Sharing Plan Variation","VT",null,"Oral Surgery"]
[null,"WA",null,"Organ Transplants"]
["Click here to select","WI",null,"Osteoporosis"]
[null,"WV",null,"Outpatient Contraceptive Services Including Sterilizations"]
["Not EHB","WY",null,"Oxygen"]
["Not EHB - Defrayed to Issuer",null,null,"Pediatric Services Other"]
["Not EHB - Defrayed to Enrollee",null,null,"Port-Wine Stain Removal"]
["Substituted",null,null,"Post-Mastectomy Care"]
["Substantially Equal",null,null,"Prescription Drugs Other"]
["Using Alternate Benchmark",null,null,"Prescription Drugs Other "]
["Other Law/Regulation",null,null,"Rape and Incest Coverage"]
["Additional EHB Benefit",null,null,"Rehabilitative Occupational Therapy"]
["Dental Only Plan Available",null,null,"Rehabilitative Physical Therapy"]
[null,null,null,"Residential Treatment for Children with Emotional Disabilities"]
["No Charge",null,null,"Second Opinion"]
["No Charge after deductible",null,null,"Second Opinions Related to Chemical Dependency and Mental Health"]
["$X",null,null,"Second Surgical Opinion"]
["$X Copay after deductible",null,null,"Services to Ventilator-Dependent Persons"]
["$X Copay with deductible",null,null,"Sickle Cell Anemia"]
["Not Applicable",null,null,"Third Opinion"]
[null,null,null,"Transplant Donor Coverage"]
["$X Copay per Stay",null,null,"Transplant Surgery—Donor Charges"]
["$X Copay per Stay with deductible",null,null,"Treatment of hemophilia"]
["$X Copay per Stay after deductible",null,null,"Treatment of Lyme Disease"]
["$X Copay per Day",null,null,"Treatment of Medical Complications of Alcoholism"]
["$X Copay per Day with deductible",null,null,"Well Child Care"]
["$X Copay per Day after deductible",null,null,"Wigs"]
["No Charge",null,null,"Wilm's Tumor"]
["No Charge after deductible",null,null,"Wound Care for Individuals with Epidermolysis Bullosa"]
["Not Applicable"]
[null,null,null,"Abortion for Which Public Funding is Prohibited"]
["No Charge",null,null,"Acupuncture"]
["No Charge after deductible",null,null,"Allergy Testing"]
["X%",null,null,"Bariatric Surgery"]
["X% Coinsurance after deductible",null,null,"Chemotherapy"]
["Not Applicable",null,null,"Chiropractic Care"]
[null,null,null,"Cosmetic Surgery"]
["Asthma",null,null,"Delivery and All Inpatient Services for Maternity Care"]
["Heart Disease",null,null,"Diabetes Education"]
["Depression",null,null,"Dialysis"]
["Diabetes",null,null,"Durable Medical Equipment"]
["High Blood Pressure & High Cholesterol",null,null,"Emergency Room Services"]
["Low Back Pain",null,null,"Emergency Transportation/Ambulance"]
["Pain Management",null,null,"Eye Glasses for Children"]
["Pregnancy",null,null,"Habilitation Services"]
["Weight Loss Programs",null,null,"Hearing Aids"]
[null,null,null,"Home Health Care Services"]
["Visit(s)",null,null,"Hospice Services"]
["Dollars",null,null,"Imaging (CT/PET Scans, MRIs)"]
["Exam(s)",null,null,"Infertility Treatment"]
["Days",null,null,"Infusion Therapy"]
["Item(s)",null,null,"Inpatient Hospital Services (e.g., Hospital Stay)"]
["Months",null,null,"Inpatient Physician and Surgical Services"]
["Treatment(s)",null,null,"Laboratory Outpatient and Professional Services"]
["Procedure(s)",null,null,"Long-Term/Custodial Nursing Home Care"]
["Hours",null,null,"Mental/Behavioral Health Inpatient Services"]
["Admission(s)",null,null,"Mental/Behavioral Health Outpatient Services"]
[null,null,null,"Non-Emergency Care When Traveling Outside the U.S."]
["Year",null,null,"Nutritional Counseling"]
["Benefit Period",null,null,"Other Practitioner Office Visit (Nurse, Physician Assistant)"]
["Lifetime",null,null,"Outpatient Facility Fee (e.g., Ambulatory Surgery Center)"]
["Month",null,null,"Outpatient Rehabilitation Services"]
["Episode",null,null,"Outpatient Surgery Physician/Surgical Services"]
["Stay",null,null,"Prenatal and Postnatal Care"]
["Transplant",null,null,"Preventive Care/Screening/Immunization"]
["6 Months",null,null,"Primary Care Visit to Treat an Injury or Illness"]
["2 Years",null,null,"Private-Duty Nursing"]
["3 Years",null,null,"Prosthetic Devices"]
["Procedure",null,null,"Radiation"]
["Week",null,null,"Reconstructive Surgery"]
["Admission",null,null,"Rehabilitative Occupational and Rehabilitative Physical Therapy"]
[null,null,null,"Rehabilitative Speech Therapy"]
["Guaranteed Rate ",null,null,"Routine Eye Exam (Adult)"]
[null,null,null,"Routine Eye Exam for Children"]
[null,null,null,"Routine Foot Care"]
["High",null,null,"Skilled Nursing Facility"]
["Low",null,null,"Specialist Visit"]
[null,null,null,"Substance Abuse Disorder Inpatient Services"]
["$X Copay per Stay",null,null,"Substance Abuse Disorder Outpatient Services"]
["$X Copay per Stay with deductible",null,null,"Transplant"]
["$X Copay per Stay after deductible",null,null,"Treatment for Temporomandibular Joint Disorders"]
["$X Copay per Day",null,null,"Urgent Care Centers or Facilities"]
["$X Copay per Day with deductible",null,null,"Weight Loss Programs"]
["$X Copay per Day after deductible",null,null,"Well Baby Visits and Care"]
["$X",null,null,"X-rays and Diagnostic Imaging"]
["$X Copay with deductible"]
["$X Copay after deductible",null,null,"Click to enter Family MOOP"]
["No Charge"]
["No Charge after deductible",null,null,"Click to enter Family Deductible"]
["Not Applicable"]
[]
["Not Applicable"]
["Design 1"]
["Design 2"]
["Design 3"]
["Design 4"]
["Design 5"]