{"text_format":"1","workbook":"xlsx","n_sheets":5,"sheets":["EnableMacros","Benefits Package 1","DefaultBP","DefaultCSV","Names"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":30,"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":false,"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."]

{"sheet":"Benefits Package 1","index":1,"n_rows":127,"n_cols":34,"rows_kept":127,"cut":false,"hidden":true,"merged":[[122,0,122,1],[123,0,123,1],[124,0,124,1],[125,0,125,1],[126,0,126,1],[121,0,121,1],[110,0,110,1],[111,0,111,1],[112,0,112,1],[113,0,113,1],[114,0,114,1],[115,0,115,1],[116,0,116,1],[117,0,117,1],[118,0,118,1],[119,0,119,1],[120,0,120,1],[109,0,109,1],[98,0,98,1],[99,0,99,1],[100,0,100,1],[101,0,101,1],[102,0,102,1],[103,0,103,1],[104,0,104,1],[105,0,105,1],[106,0,106,1],[107,0,107,1],[108,0,108,1],[97,0,97,1],[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],[72,0,72,1],[73,0,73,1],[70,0,70,1],[85,0,85,1],[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],[65,0,65,1],[66,0,66,1],[68,0,68,1],[69,0,69,1],[71,0,71,1],[67,0,67,1],[6,24,6,25],[58,0,58,2],[58,3,58,9],[6,26,6,27],[6,28,6,32],[58,10,58,11],[62,0,62,1],[63,0,63,1],[64,0,64,1],[6,7,6,23],[60,0,60,1],[61,0,61,1],[6,0,6,6],[59,0,59,1]]}
["2017 Plans & Benefits Template v6.1",null,null,"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 (PlansBenefitsAddIn.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."]
["TIN*"]
["Plan Identifiers",null,null,null,null,null,null,"Plan Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stand Alone Dental Only",null,"Plan Dates",null,"Geographic Coverage",null,null,null,null,"Plan Level 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*","Level of Coverage*","Design Type*","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","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 vs. Estimated 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*","URL for Enrollment Payment"]
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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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["2017 Plans & Benefits Template v6.1",null,null,"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 (PlansBenefitsAddIn.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."]
["TIN*"]
["Plan Identifiers",null,null,null,null,null,null,"Plan Attributes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Stand Alone Dental Only",null,"Plan Dates",null,"Geographic Coverage",null,null,null,null,"Plan Level 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*","Level of Coverage*","Design Type*","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","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 vs. Estimated 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*","URL for Enrollment Payment"]
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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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["SHOP (Small Group)","AL",null,"Anesthetics"]
[null,"AR",null,"Applied Behavior Analysis Based Therapies"]
["Bronze","AS",null,"Attention Deficit Disorder"]
["Silver","AZ",null,"Autism Spectrum Disorders"]
["Gold","CA",null,"Blood and Blood Services"]
["Platinum","CO",null,"Bone Marrow Testing"]
["Catastrophic","CT",null,"Bone Marrow Transplant"]
[null,"DC",null,"Bone Marrow Transplants for Treatment of Breast Cancer"]
["Yes","DE",null,"Bones/Joints"]
["No","FL",null,"Brain Injury"]
[null,"FM",null,"Breast Implant Removal"]
["Indemnity","GA",null,"Breast Reconstructive Surgery"]
["PPO","GU",null,"Cancer Treatments"]
["HMO","HI",null,"Cardiac Rehabilitation"]
["POS","IA",null,"Clinical Trials"]
["EPO","ID",null,"Cochlear Implants"]
[null,"IL",null,"Congenital Anomaly, including Cleft Lip/Palate"]
["Allows Adult and Child-Only","IN",null,"Contraceptive Services"]
["Allows Adult-Only","KS",null,"Coverage for Effects of Diethylstilbestrol"]
["Allows Child-Only","KY",null,"Dental Anesthesia"]
[null,"LA",null,"Developmental Needs of Children & Youth with Cancer"]
["New","MA",null,"Diabetes Care Management"]
["Existing","MD",null,"Domestic Violence Treatment"]
[null,"ME",null,"Drug Infusion Administration"]
["Yes","MH",null,"Early Intervention Services"]
["No","MI",null,"Eating Disorder Treatment"]
["Not Applicable","MN",null,"Emegency Transportation/Ambulance"]
[null,"MO",null,"Experimental or Investigational Services"]
[null,"MP",null,"Family Therapy"]
["$X","MS",null,"Gastric Electrical Stimulation"]
["Not Applicable","MT",null,"Heart Transplant"]
[null,"NC",null,"Hormone Replacement Therapy (HRT)"]
["On the Exchange","ND",null,"Human Leukocyte Antigen Testing"]
["Off the Exchange","NE",null,"Hypodermic Syringes or Needles "]
["Both","NH",null,"Infant Formulas"]
[null,"NJ",null,"Inherited Metabolic Disorder - PKU"]
["Covered","NM",null,"Mental Health Other"]
["Not Covered","NV",null,"Mental Health Parity"]
[null,"NY",null,"Morbid Obesity Treatment"]
["Standard Plan","OH",null,"Multiple Sclerosis "]
["73% AV CSR Silver Plan Variation","OK",null,"Network Retail Pharmacy (60-90 Day Supply) Covered"]
["87% AV CSR Silver Plan Variation","OR",null,"Newborn Hearing Screening"]
["94% AV CSR Silver Plan Variation","PA",null,"Newborn Services Other"]
["Zero Cost Sharing Plan Variation","PR",null,"Nutrition/Formulas"]
["Limited Cost Sharing Plan Variation","PW",null,"Off Label Prescription Drugs"]
[null,"RI",null,"Oral Surgery"]
["Click here to select","SC",null,"Organ Transplants"]
[null,"SD",null,"Osteoporosis"]
["Not EHB","TN",null,"Outpatient Contraceptive Services Including Sterilizations"]
["Substituted","TX",null,"Oxygen"]
["Substantially Equal","UT",null,"Pediatric Services Other"]
["Using Alternate Benchmark","VA",null,"Port-Wine Stain Removal"]
["Other Law/Regulation","VI",null,"Post-Mastectomy Care"]
["Additional EHB Benefit","VT",null,"Prescription Drugs Other"]
["Dental Only Plan Available","WA",null,"Prescription Drugs Other "]
[null,"WI",null,"Rape and Incest Coverage"]
["No Charge","WV",null,"Rehabilitative Occupational Therapy"]
["No Charge after deductible","WY",null,"Rehabilitative Physical Therapy"]
["$X",null,null,"Residential Treatment for Children with Emotional Disabilities"]
["$X Copay after deductible",null,null,"Second Opinion"]
["$X Copay before deductible",null,null,"Second Opinions Related to Chemical Dependency and Mental Health"]
["Not Applicable",null,null,"Second Surgical Opinion"]
[null,null,null,"Services to Ventilator-Dependent Persons"]
["$X Copay per Stay",null,null,"Sickle Cell Anemia"]
["$X Copay per Stay before deductible",null,null,"Third Opinion"]
["$X Copay per Stay after deductible",null,null,"Transplant Donor Coverage"]
["$X Copay per Day",null,null,"Transplant Surgery—Donor Charges"]
["$X Copay per Day before deductible",null,null,"Treatment of hemophilia"]
["$X Copay per Day after deductible",null,null,"Treatment of Lyme Disease"]
["No Charge",null,null,"Treatment of Medical Complications of Alcoholism"]
["No Charge after deductible",null,null,"Well Child Care"]
["Not Applicable",null,null,"Wigs"]
[null,null,null,"Wilm's Tumor"]
["No Charge",null,null,"Wound Care for Individuals with Epidermolysis Bullosa"]
["No Charge after deductible"]
["X%",null,null,"Abortion for Which Public Funding is Prohibited"]
["X% Coinsurance after deductible",null,null,"Acupuncture"]
["Not Applicable",null,null,"Allergy Testing"]
[null,null,null,"Bariatric Surgery"]
["Asthma",null,null,"Chemotherapy"]
["Heart Disease",null,null,"Chiropractic Care"]
["Depression",null,null,"Cosmetic Surgery"]
["Diabetes",null,null,"Delivery and All Inpatient Services for Maternity Care"]
["High Blood Pressure & High Cholesterol",null,null,"Diabetes Education"]
["Low Back Pain",null,null,"Dialysis"]
["Pain Management",null,null,"Durable Medical Equipment"]
["Pregnancy",null,null,"Emergency Room Services"]
["Weight Loss Programs",null,null,"Emergency Transportation/Ambulance"]
[null,null,null,"Eye Glasses for Children"]
["Visit(s)",null,null,"Habilitation Services"]
["Dollars",null,null,"Hearing Aids"]
["Exam(s)",null,null,"Home Health Care Services"]
["Days",null,null,"Hospice Services"]
["Item(s)",null,null,"Imaging (CT/PET Scans, MRIs)"]
["Months",null,null,"Infertility Treatment"]
["Treatment(s)",null,null,"Infusion Therapy"]
["Procedure(s)",null,null,"Inpatient Hospital Services (e.g., Hospital Stay)"]
["Hours",null,null,"Inpatient Physician and Surgical Services"]
["Admission(s)",null,null,"Laboratory Outpatient and Professional Services"]
[null,null,null,"Long-Term/Custodial Nursing Home Care"]
["Year",null,null,"Mental/Behavioral Health Inpatient Services"]
["Benefit Period",null,null,"Mental/Behavioral Health Outpatient Services"]
["Lifetime",null,null,"Non-Emergency Care When Traveling Outside the U.S."]
["Month",null,null,"Nutritional Counseling"]
["Episode",null,null,"Other Practitioner Office Visit (Nurse, Physician Assistant)"]
["Stay",null,null,"Outpatient Facility Fee (e.g.,  Ambulatory Surgery Center)"]
["Transplant",null,null,"Outpatient Rehabilitation Services"]
["6 Months",null,null,"Outpatient Surgery Physician/Surgical Services"]
["2 Years",null,null,"Prenatal and Postnatal Care"]
["3 Years",null,null,"Preventive Care/Screening/Immunization"]
["Procedure",null,null,"Primary Care Visit to Treat an Injury or Illness"]
["Week",null,null,"Private-Duty Nursing"]
["Admission",null,null,"Prosthetic Devices"]
[null,null,null,"Radiation"]
["Guaranteed Rate ",null,null,"Reconstructive Surgery"]
["Estimated Rate ",null,null,"Rehabilitative Occupational and Rehabilitative Physical Therapy"]
[null,null,null,"Rehabilitative Speech Therapy"]
["High",null,null,"Routine Eye Exam (Adult)"]
["Low",null,null,"Routine Eye Exam for Children"]
[null,null,null,"Routine Foot Care"]
["$X Copay per Stay",null,null,"Skilled Nursing Facility"]
["$X Copay per Stay before deductible",null,null,"Specialist Visit"]
["$X Copay per Stay after deductible",null,null,"Substance Abuse Disorder Inpatient Services"]
["$X Copay per Day",null,null,"Substance Abuse Disorder Outpatient Services"]
["$X Copay per Day before deductible",null,null,"Transplant"]
["$X Copay per Day after deductible",null,null,"Treatment for Temporomandibular Joint Disorders"]
["$X",null,null,"Urgent Care Centers or Facilities"]
["$X Copay before deductible",null,null,"Weight Loss Programs"]
["$X Copay after deductible",null,null,"Well Baby Visits and Care"]
["No Charge",null,null,"X-rays and Diagnostic Imaging"]
["No Charge after deductible"]
["Not Applicable",null,null,"Click to enter Family MOOP"]
[]
["Not Applicable",null,null,"Click to enter Family Deductible"]
["Design 1"]
["Design 2"]
["Design 3"]
["Design 4"]
["Design 5"]