{"text_format":"3","workbook":"xlsx","n_sheets":3,"sheets":["EnableMacros","Benefits Package 1","Names"],"not_rendered":{"macros":1,"defined_names":22},"read":"whole","date_system":"1900"}

{"sheet":"EnableMacros","index":0,"n_rows":23,"n_cols":2,"rows_kept":23,"merged":[[0,0,0,15],[1,0,1,15],[2,0,2,15]]}
["Plans & Benefits Template"]
[]
[]
[]
[]
[null,"If you are seeing this sheet, macros are not enabled, please follow the following steps: "]
[]
[]
[null,"If using Excel 2003:"]
[null,"1. Set the macro security setting to Medium (Recommended) or Low.  To change the macro security setting, select Tools-> "]
[null,"       Macro->Security."]
[null,"2. If the macro security setting is set to Medium, select Enable Macros when opening the workbook."]
[]
[]
[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."]
[]
[]
[null,"Note: This screen will flash momentarily when you save or finalize this workbook."]

{"sheet":"Benefits Package 1","index":1,"n_rows":98,"n_cols":40,"rows_kept":98,"hidden":true,"merged":[[6,0,6,6],[6,7,6,23],[6,24,6,25],[6,26,6,29],[6,30,6,31],[6,32,6,36],[6,37,6,39],[28,0,28,3],[28,4,28,11],[28,12,28,15],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[38,0,38,1],[39,0,39,1],[40,0,40,1],[41,0,41,1],[42,0,42,1],[43,0,43,1],[44,0,44,1],[45,0,45,1],[46,0,46,1],[47,0,47,1],[48,0,48,1],[49,0,49,1],[50,0,50,1],[51,0,51,1],[52,0,52,1],[53,0,53,1],[54,0,54,1],[55,0,55,1],[56,0,56,1],[57,0,57,1],[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]]}
["Plans & Benefits Template v1.1"]
["HIOS Issuer ID*"]
["Issuer State*"]
["Market Coverage*"]
["Dental Only Plan*"]
["TIN*"]
["Plan Identifiers",{"$nulls":6},"Plan Attributes",{"$nulls":16},"Stand Alone Dental Only",null,"AV Calculator Additional Benefit Design",{"$nulls":3},"Plan Dates",null,"Geographic Coverage",{"$nulls":4},"URLs"]
["HIOS Plan ID*\n(Standard Component)","Plan Marketing Name*","HIOS Product ID*","HPID","Network ID*","Service Area ID*","Formulary ID*","New/Existing Plan?*","Plan Type*","Metal Level*","Unique Plan Design?*","QHP/Non-QHP*","Notice Required for Pregnancy*","Is a Referral Required for Specialist?*","Specialist(s) Requiring a Referral","Plan Level Exclusions","Limited Cost Sharing Plan Variation - Est Advanced Payment","H.S.A. Eligible*","HSA/HRA Employer Contribution","HSA/HRA Employer Contribution Amount","Child-Only Offering*","Child Only Plan ID","Wellness Program Offered*","Disease Management Programs Offered","EHB Apportionment for Pediatric Dental ","Guaranteed vs. Estimated Rate ","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? ","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*","URL for Summary of Benefits & Coverage","URL for Enrollment Payment","Plan Brochure"]
{"$rows_empty":20}
["Benefit Information",{"$nulls":3},"General Information",{"$nulls":7},"Deductible and Out of Pocket Exceptions"]
["Benefits",null,"EHB","State\nMandate","Is this Benefit Covered?","Quantitative Limit on Service","Limit Quantity","Limit Unit","Minimum Stay","Exclusions","Explanation (text field)","EHB Variance Reason","Subject to Deductible (Tier 1)","Subject to Deductible \n(Tier 2)","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"]
["Non-Emergency Care When Traveling Outside the U.S."]
["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"]

{"sheet":"Names","index":2,"n_rows":107,"n_cols":4,"rows_kept":107,"hidden":true}
["Individual","AK",null,"Clinical Trials"]
["SHOP (Small Group)","AL",null,"Diabetes Care Management"]
[null,"AR",null,"Inherited Metabolic Disorder - PKU"]
["Bronze","AS",null,"Newborn Hearing Screening"]
["Silver","AZ",null,"Off Label Prescription Drugs"]
["Gold","CA",null,"Dental Anesthesia"]
["Platinum","CO",null,"Gastric Electrical Stimulation"]
["Catastrophic","CT",null,"Mental Health Other"]
[null,"DC",null,"Well Child Care"]
["Yes","DE",null,"Prescription Drugs Other"]
["No","FL",null,"Emegency Transportation/Ambulance"]
[null,"FM",null,"Coverage for Effects of Diethylstilbestrol"]
["Indemnity","GA",null,"Organ Transplants"]
["PPO","GU",null,"Second Opinion"]
["HMO","HI",null,"Congenital Anomaly, including Cleft Lip/Palate"]
["POS","IA",null,"Early Intervention Services"]
["EPO","ID",null,"Rehabilitative Occupational Therapy"]
[null,"IL",null,"Rehabilitative Physical Therapy"]
["Allows Adult and Child-Only","IN",null,"Accidental Ingestion of a Controlled Drug"]
["Allows Adult-Only","KS",null,"Bone Marrow Testing"]
["Allows Child-Only","KY",null,"Bones/Joints"]
[null,"LA",null,"Developmental Needs of Children & Youth with Cancer"]
["New","MA",null,"Mental Health Parity"]
["Existing","MD",null,"Network Retail Pharmacy (60-90 Day Supply) Covered"]
[null,"ME",null,"Post-Mastectomy Care"]
["Yes","MH",null,"Wound Care for Individuals with Epidermolysis Bullosa"]
["No","MI",null,"Treatment of Medical Complications of Alcoholism"]
["Not Applicable","MN",null,"Bone Marrow Transplant"]
[null,"MO",null,"Nutrition/Formulas"]
[null,"MP",null,"Osteoporosis"]
["$X","MS",null,"Heart Transplant"]
["Not Applicable","MT",null,"Morbid Obesity Treatment"]
[null,"NC",null,"Autism Spectrum Disorders"]
["On Exchange","ND",null,"Breast Implant Removal"]
["Off Exchange","NE",null,"Multiple Sclerosis "]
["Both","NH",null,"Prescription Drugs Other "]
[null,"NJ",null,"Applied Behavior Analysis Based Therapies"]
["Covered","NM",null,"Cochlear Implants"]
["Not Covered","NV",null,"Attention Deficit Disorder"]
[null,"NY",null,"Bone Marrow Transplants for Treatment of Breast Cancer"]
["Standard Plan","OH",null,"Cardiac Rehabilitation"]
["73% AV CSR Silver Plan Variation","OK",null,"Contraceptive Services"]
["87% AV CSR Silver Plan Variation","OR",null,"Hormone Replacement Therapy (HRT)"]
["94% AV CSR Silver Plan Variation","PA",null,"Human Leukocyte Antigen Testing"]
["Zero Cost Sharing Plan Variation","PR",null,"Hypodermic Syringes or Needles "]
["Limited Cost Sharing Plan Variation","PW",null,"Blood and Blood Services"]
[null,"RI",null,"Anesthetics"]
["Click here to select","SC",null,"Treatment of Lyme Disease"]
[null,"SD",null,"Family Therapy"]
["Above EHB","TN",null,"Oral Surgery"]
["Substituted","TX",null,"Oxygen"]
["Substantially Equal","UT",null,"Port-Wine Stain Removal"]
["Using Alternate Benchmark","VA",null,"Residential Treatment for Children with Emotional Disabilities"]
["Other Law/Regulation","VI",null,"Second Opinions Related to Chemical Dependency and Mental Health"]
["Additional EHB Benefit","VT",null,"Second Surgical Opinion"]
["Dental Only Plan Available","WA",null,"Services to Ventilator-Dependent Persons"]
[null,"WI",null,"Newborn Services Other"]
["No Charge","WV",null,"Cancer Treatments"]
["No Charge after deductible","WY",null,"Domestic Violence Treatment"]
["$X",null,null,"Infant Formulas"]
["$X Copay after deductible",null,null,"Sickle Cell Anemia"]
["$X Copay before deductible",null,null,"Third Opinion"]
[{"$nulls":3},"Treatment of hemophilia"]
["$X Copay per Day",null,null,"Wilm's Tumor"]
["$X Copay per Stay",null,null,"Breast Reconstructive Surgery"]
[{"$nulls":3},"Drug Infusion Administration"]
["No Charge",null,null,"Eating Disorder Treatment"]
["No Charge after deductible",null,null,"Experimental or Investigational Services"]
["X%",null,null,"Brain Injury"]
["X% Coinsurance after deductible",null,null,"Transplant Surgery—Donor Charges"]
[{"$nulls":3},"Wigs"]
["Asthma",null,null,"Pediatric Services Other"]
["Heart Disease",null,null,"Transplant Donor Coverage"]
["Depression",null,null,"Rape and Incest Coverage"]
["Diabetes",null,null,"Outpatient Contraceptive Services Including Sterilizations"]
["High Blood Pressure & High Cholesterol"]
["Low Back Pain"]
["Pain Management"]
["Pregnancy"]
[]
["Visit(s)"]
["Dollars"]
["Exam(s)"]
["Days"]
["Item(s)"]
["Months"]
["Treatment(s)"]
["Procedure(s)"]
["Hours"]
["Admission(s)"]
[]
["Year"]
["Benefit Period"]
["Lifetime"]
["Month"]
["Episode"]
["Stay"]
["Transplant"]
["6 Months"]
["2 Years"]
["3 Years"]
["Procedure"]
["Week"]
["Admission"]
[]
["Guaranteed Rate "]
["Estimated Rate "]