Namara Marketplace
Request data
Plan Attributes PUF - 2018
|
Businessyear
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Statecode
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Issuerid
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Sourcename
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Importdate
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Marketcoverage
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Dentalonlyplan
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Tin
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Standardcomponentid
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Planmarketingname
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Hiosproductid
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Hpid
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Networkid
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Serviceareaid
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Formularyid
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Isnewplan
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Plantype
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Metallevel
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Designtype
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Uniqueplandesign
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Qhpnonqhptypeid
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Isnoticerequiredforpregnancy
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Isreferralrequiredforspecialist
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Specialistrequiringreferral
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Planlevelexclusions
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Indianplanvariationestimatedadvancedpaymentamountperenrollee
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Compositeratingoffered
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Childonlyoffering
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Childonlyplanid
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Wellnessprogramoffered
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Diseasemanagementprogramsoffered
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Ehbpercenttotalpremium
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Ehbpediatricdentalapportionmentquantity
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Isguaranteedrate
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Planeffectivedate
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Planexpirationdate
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Outofcountrycoverage
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Outofcountrycoveragedescription
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Outofserviceareacoverage
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Outofserviceareacoveragedescription
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Nationalnetwork
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Urlforenrollmentpayment
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Formularyurl
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Planid
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Planvariantmarketingname
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Csrvariationtype
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Issueractuarialvalue
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Avcalculatoroutputnumber
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Medicaldrugdeductiblesintegrated
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Medicaldrugmaximumoutofpocketintegrated
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Multipleinnetworktiers
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Firsttierutilization
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Secondtierutilization
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Sbchavingababydeductible
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Sbchavingababycopayment
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Sbchavingababycoinsurance
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Sbchavingababylimit
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Sbchavingdiabetesdeductible
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Sbchavingdiabetescopayment
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Sbchavingdiabetescoinsurance
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Sbchavingdiabeteslimit
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Sbchavingsimplefracturedeductible
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Sbchavingsimplefracturecopayment
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Sbchavingsimplefracturecoinsurance
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Sbchavingsimplefracturelimit
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Specialtydrugmaximumcoinsurance
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Inpatientcopaymentmaximumdays
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Beginprimarycarecostsharingafternumberofvisits
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Beginprimarycaredeductiblecoinsuranceafternumberofcopays
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Mehbinntier1Individualmoop
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Mehbinntier1Familyperpersonmoop
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Mehbinntier1Familypergroupmoop
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Mehbinntier2Individualmoop
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Mehbinntier2Familyperpersonmoop
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Mehbinntier2Familypergroupmoop
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Mehboutofnetindividualmoop
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Mehboutofnetfamilyperpersonmoop
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Mehboutofnetfamilypergroupmoop
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Mehbcombinnoonindividualmoop
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Mehbcombinnoonfamilyperpersonmoop
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Mehbcombinnoonfamilypergroupmoop
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Dehbinntier1Individualmoop
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Dehbinntier1Familyperpersonmoop
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Dehbinntier1Familypergroupmoop
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Dehbinntier2Individualmoop
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Dehbinntier2Familyperpersonmoop
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Dehbinntier2Familypergroupmoop
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Dehboutofnetindividualmoop
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Dehboutofnetfamilyperpersonmoop
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Dehboutofnetfamilypergroupmoop
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Dehbcombinnoonindividualmoop
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Dehbcombinnoonfamilyperpersonmoop
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Dehbcombinnoonfamilypergroupmoop
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Tehbinntier1Individualmoop
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Tehbinntier1Familyperpersonmoop
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Tehbinntier1Familypergroupmoop
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Tehbinntier2Individualmoop
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Tehbinntier2Familyperpersonmoop
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Tehbinntier2Familypergroupmoop
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Tehboutofnetindividualmoop
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Tehboutofnetfamilyperpersonmoop
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Tehboutofnetfamilypergroupmoop
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Tehbcombinnoonindividualmoop
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Tehbcombinnoonfamilyperpersonmoop
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Tehbcombinnoonfamilypergroupmoop
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Mehbdedinntier1Individual
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Mehbdedinntier1Familyperperson
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Mehbdedinntier1Familypergroup
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Mehbdedinntier1Coinsurance
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Mehbdedinntier2Individual
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Mehbdedinntier2Familyperperson
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Mehbdedinntier2Familypergroup
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Mehbdedinntier2Coinsurance
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Mehbdedoutofnetindividual
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Mehbdedoutofnetfamilyperperson
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Mehbdedoutofnetfamilypergroup
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Mehbdedcombinnoonindividual
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Mehbdedcombinnoonfamilyperperson
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Mehbdedcombinnoonfamilypergroup
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Dehbdedinntier1Individual
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Dehbdedinntier1Familyperperson
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Dehbdedinntier1Familypergroup
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Dehbdedinntier1Coinsurance
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Dehbdedinntier2Individual
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Dehbdedinntier2Familyperperson
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Dehbdedinntier2Familypergroup
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Dehbdedinntier2Coinsurance
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Dehbdedoutofnetindividual
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Dehbdedoutofnetfamilyperperson
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Dehbdedoutofnetfamilypergroup
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Dehbdedcombinnoonindividual
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Dehbdedcombinnoonfamilyperperson
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Dehbdedcombinnoonfamilypergroup
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Tehbdedinntier1Individual
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Tehbdedinntier1Familyperperson
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Tehbdedinntier1Familypergroup
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Tehbdedinntier1Coinsurance
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Tehbdedinntier2Individual
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Tehbdedinntier2Familyperperson
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Tehbdedinntier2Familypergroup
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Tehbdedinntier2Coinsurance
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Tehbdedoutofnetindividual
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Tehbdedoutofnetfamilyperperson
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Tehbdedoutofnetfamilypergroup
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Tehbdedcombinnoonindividual
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Tehbdedcombinnoonfamilyperperson
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Tehbdedcombinnoonfamilypergroup
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Ishsaeligible
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Hsaorhraemployercontribution
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Hsaorhraemployercontributionamount
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Urlforsummaryofbenefitscoverage
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Planbrochure
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710015
|
Endeavor Providence Bronze 5500
|
73836AK071
|
AKN002
|
AKS001
|
AKF005
|
New
|
PPO
|
Expanded Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710015-01
|
Endeavor Providence Bronze 5500
|
Standard Bronze On Exchange Plan
|
0.629149713
|
Yes
|
Yes
|
f
|
1
|
5500.00
|
0.00
|
1900.00
|
300.00
|
5310.00
|
400.00
|
300.00
|
60.00
|
1460.00
|
200.00
|
30.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
5500.00
|
$5500 per person
|
$11000 per group
|
40
|
$16,500
|
$16500 per person
|
$33000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710015
|
Endeavor Providence Bronze 5500
|
73836AK071
|
AKN002
|
AKS001
|
AKF005
|
New
|
PPO
|
Expanded Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710015-00
|
Endeavor Providence Bronze 5500
|
Standard Bronze Off Exchange Plan
|
0.629149713
|
Yes
|
Yes
|
f
|
1
|
5500.00
|
0.00
|
1900.00
|
300.00
|
5310.00
|
400.00
|
300.00
|
60.00
|
1460.00
|
200.00
|
30.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
5500.00
|
$5500 per person
|
$11000 per group
|
40
|
$16,500
|
$16500 per person
|
$33000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710017
|
Endeavor Providence Bronze HDHP 3300
|
73836AK071
|
AKN002
|
AKS001
|
AKF007
|
New
|
PPO
|
Expanded Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710017-01
|
Endeavor Providence Bronze HDHP 3300
|
Standard Bronze On Exchange Plan
|
0.62828673
|
Yes
|
Yes
|
f
|
1
|
3300.00
|
0.00
|
3300.00
|
300.00
|
3300.00
|
0.00
|
1800.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
6600.00
|
$6600 per person
|
$13200 per group
|
$19,800
|
$19800 per person
|
$39600 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
3300.00
|
per person not applicable
|
$6600 per group
|
50
|
$9,900
|
per person not applicable
|
$19800 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710017
|
Endeavor Providence Bronze HDHP 3300
|
73836AK071
|
AKN002
|
AKS001
|
AKF007
|
New
|
PPO
|
Expanded Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710017-00
|
Endeavor Providence Bronze HDHP 3300
|
Standard Bronze Off Exchange Plan
|
0.62828673
|
Yes
|
Yes
|
f
|
1
|
3300.00
|
0.00
|
3300.00
|
300.00
|
3300.00
|
0.00
|
1800.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
6600.00
|
$6600 per person
|
$13200 per group
|
$19,800
|
$19800 per person
|
$39600 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
3300.00
|
per person not applicable
|
$6600 per group
|
50
|
$9,900
|
per person not applicable
|
$19800 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0880004
|
Endeavor Providence Silver HDHP 2500
|
73836AK088
|
AKN002
|
AKS001
|
AKF006
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0880004-01
|
Endeavor Providence Silver HDHP 2500
|
Standard Silver On Exchange Plan
|
0.697573394
|
Yes
|
Yes
|
f
|
1
|
2500.00
|
0.00
|
2500.00
|
300.00
|
2500.00
|
0.00
|
1300.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
5250.00
|
$5250 per person
|
$10500 per group
|
$15,750
|
$15750 per person
|
$31500 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2500.00
|
per person not applicable
|
$5000 per group
|
25
|
$7,500
|
per person not applicable
|
$15000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0880004
|
Endeavor Providence Silver HDHP 2500
|
73836AK088
|
AKN002
|
AKS001
|
AKF006
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0880004-00
|
Endeavor Providence Silver HDHP 2500
|
Standard Silver Off Exchange Plan
|
0.697573394
|
Yes
|
Yes
|
f
|
1
|
2500.00
|
0.00
|
2500.00
|
300.00
|
2500.00
|
0.00
|
1300.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
5250.00
|
$5250 per person
|
$10500 per group
|
$15,750
|
$15750 per person
|
$31500 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2500.00
|
per person not applicable
|
$5000 per group
|
25
|
$7,500
|
per person not applicable
|
$15000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0880003
|
Endeavor Providence Silver HDHP 2000
|
73836AK088
|
AKN002
|
AKS001
|
AKF006
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0880003-01
|
Endeavor Providence Silver HDHP 2000
|
Standard Silver On Exchange Plan
|
0.713552098
|
Yes
|
Yes
|
f
|
1
|
2000.00
|
0.00
|
2600.00
|
300.00
|
2000.00
|
0.00
|
1500.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
5250.00
|
$5250 per person
|
$10500 per group
|
$15,750
|
$15750 per person
|
$31500 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2000.00
|
per person not applicable
|
$4000 per group
|
25
|
$6,000
|
per person not applicable
|
$12000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0880003
|
Endeavor Providence Silver HDHP 2000
|
73836AK088
|
AKN002
|
AKS001
|
AKF006
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0880003-00
|
Endeavor Providence Silver HDHP 2000
|
Standard Silver Off Exchange Plan
|
0.713552098
|
Yes
|
Yes
|
f
|
1
|
2000.00
|
0.00
|
2600.00
|
300.00
|
2000.00
|
0.00
|
1500.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
5250.00
|
$5250 per person
|
$10500 per group
|
$15,750
|
$15750 per person
|
$31500 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2000.00
|
per person not applicable
|
$4000 per group
|
25
|
$6,000
|
per person not applicable
|
$12000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Yes
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0820004
|
Endeavor Providence Bronze 5000
|
73836AK082
|
AKN002
|
AKS001
|
AKF003
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0820004-01
|
Endeavor Providence Bronze 5000
|
Standard Bronze On Exchange Plan
|
0.59409672
|
Yes
|
Yes
|
f
|
1
|
5000.00
|
0.00
|
2400.00
|
300.00
|
5000.00
|
0.00
|
900.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
5000.00
|
$5000 per person
|
$10000 per group
|
50
|
$15,000
|
$15000 per person
|
$30000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0820004
|
Endeavor Providence Bronze 5000
|
73836AK082
|
AKN002
|
AKS001
|
AKF003
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0820004-00
|
Endeavor Providence Bronze 5000
|
Standard Bronze Off Exchange Plan
|
0.59409672
|
Yes
|
Yes
|
f
|
1
|
5000.00
|
0.00
|
2400.00
|
300.00
|
5000.00
|
0.00
|
900.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
5000.00
|
$5000 per person
|
$10000 per group
|
50
|
$15,000
|
$15000 per person
|
$30000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0820003
|
Endeavor Providence Bronze 4000
|
73836AK082
|
AKN002
|
AKS001
|
AKF003
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0820003-01
|
Endeavor Providence Bronze 4000
|
Standard Bronze On Exchange Plan
|
0.605994165
|
Yes
|
Yes
|
f
|
1
|
4000.00
|
0.00
|
3400.00
|
300.00
|
4000.00
|
0.00
|
1300.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
4000.00
|
$4000 per person
|
$8000 per group
|
50
|
$12,000
|
$12000 per person
|
$24000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze4000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze4000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0820003
|
Endeavor Providence Bronze 4000
|
73836AK082
|
AKN002
|
AKS001
|
AKF003
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0820003-00
|
Endeavor Providence Bronze 4000
|
Standard Bronze Off Exchange Plan
|
0.605994165
|
Yes
|
Yes
|
f
|
1
|
4000.00
|
0.00
|
3400.00
|
300.00
|
4000.00
|
0.00
|
1300.00
|
60.00
|
1930.00
|
0.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
4000.00
|
$4000 per person
|
$8000 per group
|
50
|
$12,000
|
$12000 per person
|
$24000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze4000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze4000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710004
|
Endeavor Providence Silver 4000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710004-01
|
Endeavor Providence Silver 4000
|
Standard Silver On Exchange Plan
|
0.700335103
|
Yes
|
Yes
|
f
|
1
|
4000.00
|
40.00
|
2900.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
4000.00
|
$4000 per person
|
$8000 per group
|
35
|
$12,000
|
$12000 per person
|
$24000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver4000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver4000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710004
|
Endeavor Providence Silver 4000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710004-00
|
Endeavor Providence Silver 4000
|
Standard Silver Off Exchange Plan
|
0.700335103
|
Yes
|
Yes
|
f
|
1
|
4000.00
|
40.00
|
2900.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
4000.00
|
$4000 per person
|
$8000 per group
|
35
|
$12,000
|
$12000 per person
|
$24000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver4000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver4000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710003
|
Endeavor Providence Silver 3000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710003-01
|
Endeavor Providence Silver 3000
|
Standard Silver On Exchange Plan
|
0.709104254
|
Yes
|
Yes
|
f
|
1
|
3000.00
|
40.00
|
3300.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
3000.00
|
$3000 per person
|
$6000 per group
|
35
|
$9,000
|
$9000 per person
|
$18000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver3000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver3000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710003
|
Endeavor Providence Silver 3000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710003-00
|
Endeavor Providence Silver 3000
|
Standard Silver Off Exchange Plan
|
0.709104254
|
Yes
|
Yes
|
f
|
1
|
3000.00
|
40.00
|
3300.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
3000.00
|
$3000 per person
|
$6000 per group
|
35
|
$9,000
|
$9000 per person
|
$18000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver3000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver3000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700004
|
Endeavor Providence Silver 2500
|
73836AK070
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700004-01
|
Endeavor Providence Silver 2500
|
Standard Silver On Exchange Plan
|
0.714196731
|
Yes
|
Yes
|
f
|
1
|
2500.00
|
40.00
|
3500.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2500.00
|
$2500 per person
|
$5000 per group
|
35
|
$7,500
|
$7500 per person
|
$15000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700004
|
Endeavor Providence Silver 2500
|
73836AK070
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700004-00
|
Endeavor Providence Silver 2500
|
Standard Silver Off Exchange Plan
|
0.714196731
|
Yes
|
Yes
|
f
|
1
|
2500.00
|
40.00
|
3500.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2500.00
|
$2500 per person
|
$5000 per group
|
35
|
$7,500
|
$7500 per person
|
$15000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710002
|
Endeavor Providence Silver 2000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710002-01
|
Endeavor Providence Silver 2000
|
Standard Silver On Exchange Plan
|
0.719996654
|
Yes
|
Yes
|
f
|
1
|
2000.00
|
40.00
|
3600.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2000.00
|
$2000 per person
|
$4000 per group
|
35
|
$6,000
|
$6000 per person
|
$12000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0710002
|
Endeavor Providence Silver 2000
|
73836AK071
|
AKN002
|
AKS001
|
AKF002
|
Existing
|
PPO
|
Silver
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0710002-00
|
Endeavor Providence Silver 2000
|
Standard Silver Off Exchange Plan
|
0.719996654
|
Yes
|
Yes
|
f
|
1
|
2000.00
|
40.00
|
3600.00
|
300.00
|
1730.00
|
1900.00
|
50.00
|
60.00
|
1460.00
|
200.00
|
20.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
2000.00
|
$2000 per person
|
$4000 per group
|
35
|
$6,000
|
$6000 per person
|
$12000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700003
|
Endeavor Providence Gold 1500
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700003-01
|
Endeavor Providence Gold 1500
|
Standard Gold On Exchange Plan
|
0.794060591
|
Yes
|
Yes
|
f
|
1
|
1500.00
|
40.00
|
2200.00
|
300.00
|
1500.00
|
1100.00
|
70.00
|
60.00
|
1190.00
|
400.00
|
10.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
1500.00
|
$1500 per person
|
$3000 per group
|
20
|
$4,500
|
$4500 per person
|
$9000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700003
|
Endeavor Providence Gold 1500
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700003-00
|
Endeavor Providence Gold 1500
|
Standard Gold Off Exchange Plan
|
0.794060591
|
Yes
|
Yes
|
f
|
1
|
1500.00
|
40.00
|
2200.00
|
300.00
|
1500.00
|
1100.00
|
70.00
|
60.00
|
1190.00
|
400.00
|
10.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
1500.00
|
$1500 per person
|
$3000 per group
|
20
|
$4,500
|
$4500 per person
|
$9000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700002
|
Endeavor Providence Gold 1000
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700002-01
|
Endeavor Providence Gold 1000
|
Standard Gold On Exchange Plan
|
0.802456118
|
Yes
|
Yes
|
f
|
1
|
1000.00
|
40.00
|
2300.00
|
300.00
|
1000.00
|
1100.00
|
200.00
|
60.00
|
1000.00
|
400.00
|
50.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
1000.00
|
$1000 per person
|
$2000 per group
|
20
|
$3,000
|
$3000 per person
|
$6000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700002
|
Endeavor Providence Gold 1000
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700002-00
|
Endeavor Providence Gold 1000
|
Standard Gold Off Exchange Plan
|
0.802456118
|
Yes
|
Yes
|
f
|
1
|
1000.00
|
40.00
|
2300.00
|
300.00
|
1000.00
|
1100.00
|
200.00
|
60.00
|
1000.00
|
400.00
|
50.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
1000.00
|
$1000 per person
|
$2000 per group
|
20
|
$3,000
|
$3000 per person
|
$6000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700001
|
Endeavor Providence Gold 500
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700001-01
|
Endeavor Providence Gold 500
|
Standard Gold On Exchange Plan
|
0.813083276
|
Yes
|
Yes
|
f
|
1
|
500.00
|
40.00
|
2400.00
|
300.00
|
500.00
|
1100.00
|
300.00
|
60.00
|
500.00
|
400.00
|
200.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
500.00
|
$500 per person
|
$1000 per group
|
20
|
$1,500
|
$1500 per person
|
$3000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0700001
|
Endeavor Providence Gold 500
|
73836AK070
|
AKN002
|
AKS001
|
AKF001
|
Existing
|
PPO
|
Gold
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0700001-00
|
Endeavor Providence Gold 500
|
Standard Gold Off Exchange Plan
|
0.813083276
|
Yes
|
Yes
|
f
|
1
|
500.00
|
40.00
|
2400.00
|
300.00
|
500.00
|
1100.00
|
300.00
|
60.00
|
500.00
|
400.00
|
200.00
|
0.00
|
0
|
0
|
0
|
7000.00
|
$7000 per person
|
$14000 per group
|
$21,000
|
$21000 per person
|
$42000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
500.00
|
$500 per person
|
$1000 per group
|
20
|
$1,500
|
$1500 per person
|
$3000 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0810002
|
Endeavor Providence Bronze 7350
|
73836AK081
|
AKN002
|
AKS001
|
AKF004
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0810002-01
|
Endeavor Providence Bronze 7350
|
Standard Bronze On Exchange Plan
|
0.605988703
|
Yes
|
Yes
|
f
|
1
|
7350.00
|
0.00
|
0.00
|
300.00
|
5310.00
|
800.00
|
0.00
|
60.00
|
1460.00
|
400.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
7350.00
|
$7350 per person
|
$14700 per group
|
0
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
73836
|
HIOS
|
2017-09-02 02:21:00
|
SHOP (Small Group)
|
f
|
93-0989307
|
73836AK0810002
|
Endeavor Providence Bronze 7350
|
73836AK081
|
AKN002
|
AKS001
|
AKF004
|
Existing
|
PPO
|
Bronze
|
Not Applicable
|
No
|
Both
|
No
|
No
|
t
|
Allows Adult and Child-Only
|
No
|
Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
|
2018-01-01 00:00:00
|
f
|
t
|
Travel Network
|
f
|
http://www.modahealth.com/pdl?type=SG&state=AK
|
73836AK0810002-00
|
Endeavor Providence Bronze 7350
|
Standard Bronze Off Exchange Plan
|
0.605988703
|
Yes
|
Yes
|
f
|
1
|
7350.00
|
0.00
|
0.00
|
300.00
|
5310.00
|
800.00
|
0.00
|
60.00
|
1460.00
|
400.00
|
0.00
|
0.00
|
0
|
0
|
0
|
7350.00
|
$7350 per person
|
$14700 per group
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
7350.00
|
$7350 per person
|
$14700 per group
|
0
|
$22,050
|
$22050 per person
|
$44100 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
No
|
No
|
https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf
|
https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020006
|
BESTOne Basic Silver
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020006-01
|
BESTOne Basic Silver
|
Standard Low On Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Basic-Silver_Plan.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020006
|
BESTOne Basic Silver
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020006-00
|
BESTOne Basic Silver
|
Standard Low Off Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Basic-Silver_Plan.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020005
|
BESTOne Plus Silver
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020005-00
|
BESTOne Plus Silver
|
Standard Low Off Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Silver_Plan.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020004
|
BESTOne Plus Gold
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020004-01
|
BESTOne Plus Gold
|
Standard High On Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
$150 per group
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Gold_Plan.pdf
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020004
|
BESTOne Plus Gold
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020004-00
|
BESTOne Plus Gold
|
Standard High Off Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
$150 per group
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Gold_Plan.pdf
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020003
|
BESTOne Advantage Gold
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020003-01
|
BESTOne Advantage Gold
|
Standard High On Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
$150 per group
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020003
|
BESTOne Advantage Gold
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020003-00
|
BESTOne Advantage Gold
|
Standard High Off Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
$150 per group
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
95-6042390
|
74819AK0020005
|
BESTOne Plus Silver
|
74819AK002
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Estimated Rate
|
2018-01-01 00:00:00
|
12/31/2018 12:00:00 AM
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0020005-01
|
BESTOne Plus Silver
|
Standard Low On Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Silver_Plan.pdf
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010012
|
BESTDental Value
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010012-01
|
BESTDental Value
|
Standard Low On Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010012
|
BESTDental Value
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010012-00
|
BESTDental Value
|
Standard Low Off Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010011
|
BESTDental Choice - L
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010011-01
|
BESTDental Choice - L
|
Standard Low On Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010008
|
BESTDental Standard - H
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010008-00
|
BESTDental Standard - H
|
Standard High Off Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010007
|
BESTDental Premium
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010007-01
|
BESTDental Premium
|
Standard High On Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010007
|
BESTDental Premium
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010007-00
|
BESTDental Premium
|
Standard High Off Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010011
|
BESTDental Choice - L
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010011-00
|
BESTDental Choice - L
|
Standard Low Off Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010009
|
BESTDental Standard - L
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010009-01
|
BESTDental Standard - L
|
Standard Low On Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010009
|
BESTDental Standard - L
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010009-00
|
BESTDental Standard - L
|
Standard Low Off Exchange Plan
|
0.708
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$75
|
$75 per person
|
per group not applicable
|
$100
|
$100 per person
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010010
|
BESTDental Choice - H
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010010-01
|
BESTDental Choice - H
|
Standard High On Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010010
|
BESTDental Choice - H
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010010-00
|
BESTDental Choice - H
|
Standard High Off Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AK
|
74819
|
HIOS
|
2017-08-08 02:20:00
|
SHOP (Small Group)
|
t
|
95-6042390
|
74819AK0010008
|
BESTDental Standard - H
|
74819AK001
|
AKN001
|
AKS001
|
Existing
|
PPO
|
High
|
Not Applicable
|
Both
|
f
|
Allows Adult and Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
f
|
t
|
Full
|
t
|
http://www.bestlife.com/exchange/payment_option.html
|
74819AK0010008-01
|
BESTDental Standard - H
|
Standard High On Exchange Plan
|
0.87
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
$700
|
$700 per person
|
$1400 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
50
|
$50 per person
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AL
|
18756
|
HIOS
|
2017-05-25 02:20:00
|
SHOP (Small Group)
|
t
|
13-5581829
|
18756AL0140001
|
EHB Basic Dental Plan (Low)
|
18756AL014
|
ALN001
|
ALS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
Off the Exchange
|
When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.
|
f
|
Allows Child-Only
|
1
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
t
|
Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.
|
t
|
The PPO plan has an indemnity schedule of benefits for out of service area coverage.
|
t
|
18756AL0140001-00
|
EHB Basic Dental Plan (Low)
|
Standard Low Off Exchange Plan
|
0.7
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$100
|
per person not applicable
|
per group not applicable
|
$100
|
per person not applicable
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
2018
|
AL
|
44580
|
HIOS
|
2017-08-08 02:20:00
|
Individual
|
t
|
39-1263473
|
44580AL0380001
|
Humana Dental Smart Choice - Low
|
44580AL038
|
ALN001
|
ALS001
|
Existing
|
PPO
|
Low
|
Not Applicable
|
On the Exchange
|
f
|
Allows Adult and Child-Only
|
0
|
Guaranteed Rate
|
2018-01-01 00:00:00
|
t
|
Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.
|
t
|
Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.
|
t
|
https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage
|
44580AL0380001-01
|
Humana Dental Smart Choice - Low
|
Standard Low On Exchange Plan
|
0.699
|
f
|
1
|
0
|
0
|
0
|
$350
|
$350 per person
|
$700 per group
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
Not Applicable
|
per person not applicable
|
per group not applicable
|
$35
|
per person not applicable
|
per group not applicable
|
$35
|
per person not applicable
|
per group not applicable
|
per person not applicable
|
per group not applicable
|
http://apps.humana.com/marketing/documents.asp?file=3110237
|
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