BUSINESS YEAR,STATE CODE,ISSUER NAME,ISSUER ID,SOURCE NAME,VERSION NUMBER,IMPORT DATE,BENEFIT PACKAGE ID,MARKET COVERAGE,DENTAL ONLY PLAN,TIN,STANDARD COMPONENT ID,PLAN MARKETING NAME,HIOS PRODUCT ID,HPID,NETWORK ID,SERVICE AREA ID,FORMULARY ID,IS IT A NEW PLAN,PLAN TYPE,METAL LEVEL,UNIQUE PLAN DESIGN,QHP NONQHP TYPE ID,IS NOTICE REQUIRED FOR PREGNACY,IS REFERRAL REQUIRED FOR SPECIALIST,SPECIALIST REQUIRING REFERRAL,PLAN LEVEL EXCLUSIONS,IS HSA ELIGIBLE,HSA OR HRA EMPLOYER CONTRIBUTION,HSA OR HRA EMPLOYER CONTRIBUTION AMOUNT,CHILD ONLY OFFERING,CHILD ONLY PLAN ID,WELLNESS PROGRAM OFFERED,DISEASE MANAGEMENT PROGRAMS OFFERED,EHB PEDIATRIC DENTAL APPORTIONMENT QUANTITY,IS GUARANTEED RATE?,SPECIALITY DRUG MAXIMUM COINSURANCE,INPATIENT COPAYMENT MAXIMUM DAYS,BEGIN PRIMARY CARE COST SHARING AFTER NUMBER OF VISITS,BEGIN PRIMARY CARE DEDUCTIBLE COINSURANCE AFTER NUMBER OF COPAYS,PLAN EFFECTIVE DATE,PLAN EXPIRATION DATE,OUT OF COUNTRY COVERAGE,OUT OF COUNTRY COVERAGE DESCRIPTION,OUT OF SERVICE AREA COVERAGE,OUT OF SERVICE AREA COVERAGE DESCRIPTION,NATIONAL NETWORK,URL FOR SUMMARY OF BENEFITS COVERAGE,URL FOR ENROLLMENT PAYMENT,PLAN BROCHURE,FORMULARY URL,PLAN ID,CSR VARIATION TYPE,ISSUER ACTUARIAL VALUE,AV CALCULATOR OUTPUT NUMBER,MEDICAL DRUG DEDUCTIBLES INTEGRATED,MEDICAL DRUG MAXIMUM OUT OF POCKET INTEGRATED,MULTIPLE NETWORK TIERS,FIRST TIER UTILIZATION,SECOND TIER UTILIZATION,MEHB INN TIER 1 INDIVIDUAL MOOP,MEHB INN TIER 1 FAMILY MOOP,MEHB INN TIER 2 INDIVIDUAL MOOP,MEHB INN TIER 2 FAMILY MOOP,MEHB OUT OF NET INDIVIDUAL MOOP,MEHB OUT OF NET FAMILY MOOP,MEHB COMB INN OON INDIVIDUAL MOOP,MEHB COMB INN OON FAMILY MOOP,DEHB INN TIER 1 INDIVIDUAL MOOP,DEHB INN TIER 2 INDIVIDUAL MOOP,DEHB INN TIER 1 FAMILY MOOP,DEHB INN TIER 2 FAMILY MOOP,DEHB OUT OF NET INDIVIDUAL MOOP,DEHB OUT OF NET FAMILY MOOP,DEHB COMB INN OON INDIVIDUAL MOOP,DEHB COMB INN OON FAMILY MOOP,TEHB INN TIER 1 INDIVIDUAL MOOP,TEHB INN TIER 1 FAMILY MOOP,TEHB INN TIER 2 INDIVIDUAL MOOP,TEHB INN TIER 2 FAMILY MOOP,TEHB OUT OF NET INDIVIDUAL MOOP,TEHB OUT OF NET FAMILY MOOP,TEHB COMB INN OON INDIVIDUAL MOOP,TEHB COMB INN OON FAMILY MOOP,MEHB DED INN TIER1 INDIVIDUAL,MEHB DED INN TIER1 FAMILY,MEHB DED INN TIER1 COINSURNACE,MEHB DED INN TIER2 INDIVIDUAL,MEHB DED INN TIER2 FAMILY,MEHB DED INN TIER2 COINSURANCE,MEHB DED OUT OF NET INDIVIDUAL,MEHB DED OUT OF NET FAMILY,MEHB DED COMB INN OON INDIVIDUAL,MEHB DED COMB INN OON FAMILY,DEHB DED INN TIER1 INDIVIDUAL,DEHB DED INN TIER1 FAMILY,DEHB DED INN TIER1 COINSURNACE,DEHB DED INN TIER2 INDIVIDUAL,DEHB DED INN TIER2 FAMILY,DEHB DED INN TIER2 COINSURANCE,DEHB DED OUT OF NET INDIVIDUAL,DEHB DED OUT OF NET FAMILY,DEHB DED COMB INN OON INDIVIDUAL,DEHB DED COMB INN OON FAMILY,TEHB DED INN TIER 1 INDIVIDUAL,TEHB DED INN TIER 1 FAMILY,TEHB DED INN TIER 1 COINSURANCE,TEHB DED INN TIER 2 INDIVIDUAL,TEHB DED INN TIER 2 FAMILY,TEHB DED INN TIER 2 COINSURANCE,TEHB DED OUT OF NET INDIVIDUAL,TEHB DED OUT OF NET FAMILY,TEHB DED OUT COMB INN OON INDIVIDUAL,TEHB DED OUT COMB INN OON FAMILY,SBC HAVING A BABY DEDUCTIBLE,SBC HAVING A BABY COPAYMENT,SBC HAVING A BABY COINSURANCE,SBC HAVING A BABY LIMIT,SBC HAVING DIABETES DEDUCTIBLE,SBC HAVING  DIABETES COPAYMENT,SBC HAVING DIABETES COINSURANCE,SBC HAVING DIABETES LIMIT
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080001,"GoldPlus-G1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080001-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080001,"GoldPlus-G1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080001,"GoldPlus-G1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080001-03,Limited Cost Sharing Plan Variation,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080002,"GoldPlus-G1, ST, INN, Pediatric Dental,  Dep29, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080002-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080002,"GoldPlus-G1, ST, INN, Pediatric Dental,  Dep29, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0080002,"GoldPlus-G1, ST, INN, Pediatric Dental,  Dep29, Healthy Living Rewards",11177NY008,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030003,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0080002-03,Limited Cost Sharing Plan Variation,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-04,73% AV Level Silver Plan,73.86%,0.718060702,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,900 ","$1,640 ",$0 ,"$6,300 ","$1,900 ",$480 ,$0 ,"$6,300 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-05,87% AV Level Silver Plan,87.42%,0.863675934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$800 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$400 ,$345 ,$0 ,"$2,000 ",$400 ,$240 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$140 ,$0 ,"$1,000 ",$0 ,$180 ,$0 ,"$1,000 "
2019,NY,"Delta Dental of New York, Inc.",10345,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,11-1980218,10345NY0010006,Delta Dental PPO Basic Plan for Families NS OON  Family Dental Dep 25,10345NY001,,NYN001,NYS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Nationwide Network,Yes,,https://www.deltadentalins.com/hx/checkout,,,10345NY0010006-01,Standard Low On Exchange Plan,70.80%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$65 ,$195 per group,,,,,$65 ,$195 per group,$65 ,$195 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Delta Dental of New York, Inc.",10345,SBE-PUF,1,3/4/2019 0:00,3,Individual,Yes,11-1980218,10345NY0030007,DeltaCare USA Pediatric Basic Plan ST INN Pediatric Dental Dep 19,10345NY003,,NYN002,NYS002,,Existing,HMO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.deltadentalins.com/hx/checkout,,,10345NY0030007-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Delta Dental of New York, Inc.",10345,SBE-PUF,1,3/4/2019 0:00,4,Individual,Yes,11-1980218,10345NY0030009,DeltaCare USA Basic Plan for Families NS INN Family Dental Dep 25,10345NY003,,NYN002,NYS002,,Existing,HMO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.deltadentalins.com/hx/checkout,,,10345NY0030009-01,Standard Low On Exchange Plan,68.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010001,"BronzePlus-B1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010001-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010001,"BronzePlus-B1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010001,"BronzePlus-B1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010001-03,Limited Cost Sharing Plan Variation,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010002,"BronzePlus-B1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010002-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010002,"BronzePlus-B1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0010002,"BronzePlus-B1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY001,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030001,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0010002-03,Limited Cost Sharing Plan Variation,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030001,"BronzePlus-B3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030001-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030001,"BronzePlus-B3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030001,"BronzePlus-B3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030001-03,Limited Cost Sharing Plan Variation,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-03,Limited Cost Sharing Plan Variation,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-04,73% AV Level Silver Plan,73.99%,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,650 ",$0 ,"$6,075 ","$1,350 ",$120 ,$0 ,"$6,075 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-05,87% AV Level Silver Plan,86.86%,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$275 ,$0 ,"$2,100 ",$250 ,$275 ,$0 ,"$2,100 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030002,"SilverPlus-S3, ST, INN,  Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030002-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$125 ,$0 ,"$1,000 ",$0 ,$125 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030003,"GoldPlus-G3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030003-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030003,"GoldPlus-G3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030003-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030003,"GoldPlus-G3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030003-03,Limited Cost Sharing Plan Variation,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030004,"PlatinumPlus-P3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030004-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030004,"PlatinumPlus-P3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030004-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0030004,"PlatinumPlus-P3, ST, INN, Pediatric Dental, Child Only, Healthy Living Rewards",11177NY003,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0030004-03,Limited Cost Sharing Plan Variation,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-03,Limited Cost Sharing Plan Variation,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-04,73% AV Level Silver Plan,73.99%,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,650 ",$0 ,"$6,075 ","$1,350 ",$120 ,$0 ,"$6,075 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-05,87% AV Level Silver Plan,86.86%,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$275 ,$0 ,"$2,100 ",$250 ,$275 ,$0 ,"$2,100 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040001,"SilverPlus-S1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040001-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$125 ,$0 ,"$1,000 ",$0 ,$125 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-03,Limited Cost Sharing Plan Variation,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-04,73% AV Level Silver Plan,73.99%,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,650 ",$0 ,"$6,075 ","$1,350 ",$120 ,$0 ,"$6,075 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-05,87% AV Level Silver Plan,86.86%,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$275 ,$0 ,"$2,100 ",$250 ,$275 ,$0 ,"$2,100 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0040002,"SilverPlus-S1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY004,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030002,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0040002-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$125 ,$0 ,"$1,000 ",$0 ,$125 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0050001,"SilverPlus-S4 , ST,  INN,  Pediatric Dental, Dep25, DP,  FP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050001-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0050002,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep29, DP,  FP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050002-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0050003,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep25, FP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050003-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0050004,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep29, FP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050004-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0090001,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep25, DP,  FP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090001-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0090002,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep29, DP,  FP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090002-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0090003,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep25, FP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090003-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0090004,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep29, FP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090004-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110001,"PlatinumPlus-P1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110001-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110001,"PlatinumPlus-P1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110001,"PlatinumPlus-P1, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110001-03,Limited Cost Sharing Plan Variation,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110002,"PlatinumPlus-P1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110002-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110002,"PlatinumPlus-P1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0110002,"PlatinumPlus-P1, ST, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY011,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult-Only,11177NY0030004,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0110002-03,Limited Cost Sharing Plan Variation,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0120001,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep25, DP,  FP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120001-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0120002,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep29, DP,  FP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120002-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0120003,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep25, FP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120003-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-4115686,11177NY0120004,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep29, FP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120004-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0140001,"MedPlus-M1, Catastrophic, ST, INN, Healthy Living Rewards",11177NY014,,NYN001,NYS001,NYF001,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0140001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,"$7,900 ",$15800 per group,"$7,900 ",$0 ,$0 ,"$7,900 ",$600 ,$0 ,$0 ,"$7,900 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210001,"GoldPrime-G1, ST3PCP, Gold, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210001-01,Standard Gold On Exchange Plan,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210001,"GoldPrime-G1, ST3PCP, Gold, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210001,"GoldPrime-G1, ST3PCP, Gold, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210001-03,Limited Cost Sharing Plan Variation,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210002,"GoldPrime-G1, ST3PCP Gold, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210002-01,Standard Gold On Exchange Plan,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210002,"GoldPrime-G1, ST3PCP Gold, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0210002,"GoldPrime-G1, ST3PCP Gold, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY021,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0210002-03,Limited Cost Sharing Plan Variation,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-01,Standard Silver On Exchange Plan,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-03,Limited Cost Sharing Plan Variation,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-04,73% AV Level Silver Plan,73.86%,0.718060702,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,900 ","$1,640 ",$0 ,"$6,300 ","$1,900 ",$480 ,$0 ,"$6,300 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-05,87% AV Level Silver Plan,87.42%,0.863675934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$800 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$400 ,$345 ,$0 ,"$2,000 ",$400 ,$240 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230001,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230001-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$140 ,$0 ,"$1,000 ",$0 ,$180 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-01,Standard Silver On Exchange Plan,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-03,Limited Cost Sharing Plan Variation,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-04,73% AV Level Silver Plan,73.86%,0.718060702,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,900 ","$1,640 ",$0 ,"$6,300 ","$1,900 ",$480 ,$0 ,"$6,300 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-05,87% AV Level Silver Plan,87.42%,0.863675934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$800 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$400 ,$345 ,$0 ,"$2,000 ",$400 ,$240 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0230002,"SilverPrime-S1, ST3PCP Silver, INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY023,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0230002-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$140 ,$0 ,"$1,000 ",$0 ,$180 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-01,Standard Silver On Exchange Plan,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270001,"SilverPrime-S3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270001-03,Limited Cost Sharing Plan Variation,71.82%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270002,"GoldPrime-G3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270002-01,Standard Gold On Exchange Plan,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270002,"GoldPrime-G3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270002,"GoldPrime-G3, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF006,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270002-03,Limited Cost Sharing Plan Variation,79.52%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270003,"BronzePlus-B3 HSA, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270003-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$0 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270003,"BronzePlus-B3 HSA, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270003-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-4115686,11177NY0270003,"BronzePlus-B3 HSA, Child-Only, ST, INN, Pediatric Dental, Healthy Living Rewards",11177NY027,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0270003-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$0 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-4115686,11177NY0020005,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020005-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-4115686,11177NY0020006,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020006-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-4115686,11177NY0020007,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep25, DP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020007-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-4115686,11177NY0020008,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep29, DP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020008-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ","$1,650 ",$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-03,Limited Cost Sharing Plan Variation,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ","$1,650 ",$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-04,73% AV Level Silver Plan,73.99%,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,650 ",$0 ,"$6,075 ","$1,350 ",$120 ,$0 ,"$6,075 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-05,87% AV Level Silver Plan,86.86%,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$275 ,$0 ,"$2,100 ",$250 ,$275 ,$0 ,"$2,100 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070001,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070001-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$125 ,$0 ,$125 ,$0 ,$125 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-01,Standard Silver On Exchange Plan,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-03,Limited Cost Sharing Plan Variation,71.98%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-04,73% AV Level Silver Plan,73.99%,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,650 ",$0 ,"$6,075 ","$1,350 ",$120 ,$0 ,"$6,075 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-05,87% AV Level Silver Plan,86.86%,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$275 ,$0 ,"$2,100 ",$250 ,$275 ,$0 ,"$2,100 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0070002,"SilverPlus-S2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY007,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0070002-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$125 ,$0 ,$125 ,$0 ,$125 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160001,"BronzePlus-B2, NS,  INN,  Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160001-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160001,"BronzePlus-B2, NS,  INN,  Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160001,"BronzePlus-B2, NS,  INN,  Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160001-03,Limited Cost Sharing Plan Variation,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160002,"BronzePlus-B2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160002-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160002,"BronzePlus-B2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0160002,"BronzePlus-B2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY016,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0160002-03,Limited Cost Sharing Plan Variation,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170001,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170001-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170001,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170001,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170001-03,Limited Cost Sharing Plan Variation,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170002,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170002-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170002,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0170002,"GoldPlus-G2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY017,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0170002-03,Limited Cost Sharing Plan Variation,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180001,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180001-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180001,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180001,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep25, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180001-03,Limited Cost Sharing Plan Variation,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180002,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180002-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180002,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0180002,"PlatinumPlus-P2, NS,  INN, Family Dental, Family Vision, Dep29, Healthy Living Rewards",11177NY018,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0180002-03,Limited Cost Sharing Plan Variation,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220001,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220001-01,Standard Gold On Exchange Plan,78.47%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220001,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220001,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220001-03,Limited Cost Sharing Plan Variation,78.47%,0.78051009,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220002,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220002-01,Standard Gold On Exchange Plan,78.47%,0.780509247,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220002,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0220002,"GoldPrime-G2, NS3PCP Gold, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY022,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0220002-03,Limited Cost Sharing Plan Variation,78.47%,0.780509247,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,130 ",$0 ,"$5,000 ",$650 ,$120 ,$0 ,"$5,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-01,Standard Silver On Exchange Plan,71.00%,0.706320741,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-03,Limited Cost Sharing Plan Variation,71.00%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-04,73% AV Level Silver Plan,73.86%,0.725778195,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,900 ","$1,640 ",$0 ,"$6,300 ","$1,900 ",$480 ,$0 ,"$6,300 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-05,87% AV Level Silver Plan,87.42%,0.863675934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$800 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$400 ,$345 ,$0 ,"$2,000 ",$400 ,$240 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240001,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240001-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$140 ,$0 ,"$1,000 ",$0 ,$180 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-01,Standard Silver On Exchange Plan,71.00%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-03,Limited Cost Sharing Plan Variation,71.00%,0.696932822,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,350 ","$1,640 ",$0 ,"$7,750 ","$2,350 ",$480 ,$0 ,"$7,750 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0120007,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep25, DP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120007-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0120008,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep29, DP, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120008-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180001,Standard Platinum ST OON Dep25,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180001-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,$0 ,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$800.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180001,Standard Platinum ST OON Dep25,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180001,Standard Platinum ST OON Dep25,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180001-03,Limited Cost Sharing Plan Variation,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$800.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180002,Standard Platinum ST OON Dep29,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180002-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,$0 ,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$800.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180002,Standard Platinum ST OON Dep29,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-04,73% AV Level Silver Plan,73.86%,0.725778195,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,900 ","$1,640 ",$0 ,"$5,700 ","$1,900 ",$480 ,$0 ,"$6,300 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-05,87% AV Level Silver Plan,87.42%,0.863675934,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$800 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$400 ,$345 ,$0 ,"$2,000 ",$400 ,$240 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0240002,"SilverPrime-S2, NS3PCP Silver, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0240002-06,94% AV Level Silver Plan,93.94%,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$140 ,$0 ,"$1,000 ",$0 ,$180 ,$0 ,"$1,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260001,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260001-01,Standard Bronze On Exchange Plan,62.11%,0.650442041,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$210 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260001,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260001-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260001,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep25, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260001-03,Limited Cost Sharing Plan Variation,62.11%,0.650442041,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$210 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260002,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260002-01,Standard Bronze On Exchange Plan,62.11%,0.650442041,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$210 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260002,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260002-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-4115686,11177NY0260002,"BronzePlus-B2 HSA, NS Bronze, INN, Pediatric Dental, Dep29, Family Dental, Family Vision, Healthy Living Rewards",11177NY026,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0260002-03,Limited Cost Sharing Plan Variation,62.11%,0.650442041,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$35 ,$900 ,"$6,550 ","$5,500 ",$420 ,$210 ,"$6,550 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-4115686,11177NY0020001,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep25, DP,  FP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020001-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-4115686,11177NY0020002,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep29, DP,  FP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020002-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-4115686,11177NY0020003,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep25, FP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020003-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-4115686,11177NY0020004,"BronzePlus-B4, ST,  INN, Pediatric Dental, Dep29, FP, Healthy Living Rewards",11177NY002,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0020004-01,Standard Bronze On Exchange Plan,61.99%,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$35 ,$900 ,"$7,600 ","$4,000 ",$420 ,$210 ,"$7,600 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0050005,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050005-01,Standard Silver On Exchange Plan,71.99%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0050006,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050006-01,Standard Silver On Exchange Plan,71.99%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0050007,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep25, DP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050007-01,Standard Silver On Exchange Plan,71.99%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0050008,"SilverPlus-S4, ST,  INN, Pediatric Dental, Dep29,  DP, Healthy Living Rewards",11177NY005,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0050008-01,Standard Silver On Exchange Plan,71.99%,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,650 ",$0 ,"$7,500 ","$1,700 ",$120 ,$0 ,"$7,500 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0090005,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090005-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0090006,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090006-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0090007,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep25, DP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090007-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0090008,"GoldPlus-G4, ST,  INN, Pediatric Dental, Dep29, DP, Healthy Living Rewards",11177NY009,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0090008-01,Standard Gold On Exchange Plan,79.77%,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,100 ",$0 ,"$4,000 ",$600 ,$120 ,$0 ,"$4,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0120005,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep25, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120005-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,MetroPlus Health Plan,11177,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-4115686,11177NY0120006,"PlatinumPlus-P4, ST,  INN, Pediatric Dental, Dep29, Healthy Living Rewards",11177NY012,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All specialists with the exception of assigned Primary and preventive obstetric and gynecologic provider,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.metroplus.org/member-services/paymybill,,http://www.metroplus.org/member-services/formularies,11177NY0120006-01,Standard Platinum On Exchange Plan,88.01%,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,100 ",$0 ,"$2,000 ",$0 ,$120 ,$0 ,"$2,000 "
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180002,Standard Platinum ST OON Dep29,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1180009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180002-03,Limited Cost Sharing Plan Variation,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$800.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180009,Standard Platinum Child Only ST OON Dep21,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180009-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$800.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180009,Standard Platinum Child Only ST OON Dep21,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1180009,Standard Platinum Child Only ST OON Dep21,18029NY118,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180009-03,Limited Cost Sharing Plan Variation,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220001,Standard Gold ST OON Dep25 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220001-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220001,Standard Gold ST OON Dep25 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220001,Standard Gold ST OON Dep25 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220001-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220002,Standard Gold ST OON Dep29 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220002-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220002,Standard Gold ST OON Dep29 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220002,Standard Gold ST OON Dep29 Wellness,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1220009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220002-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1240003,Standard Silver ST OON Dep29 DP FP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240003-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,400.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,400.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-05,87% AV Level Silver Plan,86.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$200.00 ,$500.00 ,$0.00 ,$60.00 ,$200.00 ,$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-06,94% AV Level Silver Plan,93.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$200.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,400.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,400.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-05,87% AV Level Silver Plan,86.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260009,Standard Silver Child Only ST OON Dep21 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260009-06,94% AV Level Silver Plan,93.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 ,$0.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1290001,Catastrophic ST INN Dep25 Wellness,18029NY129,,NYN001,NYS001,NYF027,Existing,EPO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency coverage only,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1290001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,700.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1300003,Standard Bronze ST OON Dep29 DP FP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300003-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1300008,Standard Bronze ST OON Dep25 DP FP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300008-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1300011,Standard Bronze ST OON Dep29 FP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300011-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310010,Standard Bronze ST OON Dep29 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310010,Standard Bronze ST OON Dep29 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310010-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310013,Standard Bronze Child Only ST OON Dep21 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310013-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310013,Standard Bronze Child Only ST OON Dep21 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310013,Standard Bronze Child Only ST OON Dep21 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310013-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180021,FlexFit Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180021-01,Standard Platinum On Exchange Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$600.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180021,FlexFit Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180021-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180021,FlexFit Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180021-03,Limited Cost Sharing Plan Variation,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$600.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180022,FlexFit Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180022-01,Standard Platinum On Exchange Plan,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$600.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180022,FlexFit Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1180022,FlexFit Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN001,NYS001,NYF028,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180022-03,Limited Cost Sharing Plan Variation,86.10%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$600.00 ,$0.00 ,$60.00 ,$0.00 ,"$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220021,iDirect Gold Copay NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220021-01,Standard Gold On Exchange Plan,77.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220021,iDirect Gold Copay NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220021-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220021,iDirect Gold Copay NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220021-03,Limited Cost Sharing Plan Variation,77.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220022,iDirect Gold Copay NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220022-01,Standard Gold On Exchange Plan,77.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220022,iDirect Gold Copay NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1220022,iDirect Gold Copay NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN001,NYS001,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220022-03,Limited Cost Sharing Plan Variation,77.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1240001,Standard Silver ST OON Dep25,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1240004,Standard Silver ST OON Dep29 DP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240004-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1240005,Standard Silver ST OON Dep25 DP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240005-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1240013,Standard Silver ST OON Dep29,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240013-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-06,94% AV Level Silver Plan,93.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0.00 ,$300.00 ,$0.00 ,$60.00 ,$0.00 ,$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-01,Standard Silver On Exchange Plan,68.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,950 ",$3900 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,900.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,900.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-03,Limited Cost Sharing Plan Variation,68.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,950 ",$3900 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,900.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,900.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-04,73% AV Level Silver Plan,72.16%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,500.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-05,87% AV Level Silver Plan,86.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350 ",$4700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0.00 ,"$1,200.00 ",$0.00 ,$60.00 ,$0.00 ,"$1,600.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260013,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260013-06,94% AV Level Silver Plan,93.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0.00 ,$300.00 ,$0.00 ,$60.00 ,$0.00 ,$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1300001,Standard Bronze ST OON Dep25,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1300004,Standard Bronze ST OON Dep29 DP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300004-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1300005,Standard Bronze ST OON Dep25 DP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300005-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1483784,18029NY1300013,Standard Bronze ST OON Dep29,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300013-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310033,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310033-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000.00 ",$0.00 ,"$1,700.00 ",$60.00 ,"$5,000.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310033,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310033-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310033,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310033-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000.00 ",$0.00 ,"$1,700.00 ",$60.00 ,"$5,000.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310034,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310034-01,Standard Bronze On Exchange Plan,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000.00 ",$0.00 ,"$1,700.00 ",$60.00 ,"$5,000.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310034,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310034-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1310034,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY131,,NYN001,NYS001,NYF008,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310034-03,Limited Cost Sharing Plan Variation,61.50%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000.00 ",$0.00 ,"$1,700.00 ",$60.00 ,"$5,000.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170017,FlexFit Platinum Copay NYS OON NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170017-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220009,Standard Gold Child Only ST OON Dep21,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220009-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220009,Standard Gold Child Only ST OON Dep21,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220009-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1220009,Standard Gold Child Only ST OON Dep21,18029NY122,,NYN001,NYS001,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220009-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600.00 ,"$1,300.00 ",$0.00 ,$60.00 ,$600.00 ,"$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1240008,Standard Silver ST OON Dep25 DP FP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240008-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1240011,Standard Silver ST OON Dep29  FP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240011-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1240014,Standard Silver ST OON Dep25 FP,18029NY124,,NYN001,NYS001,NYF019,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240014-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,400.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,400.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$200.00 ,$500.00 ,$0.00 ,$60.00 ,$200.00 ,$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260001,Standard Silver ST OON Dep25 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260001-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$200.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170020,FlexFit Platinum Copay NYS OON NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170020-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170022,FlexFit Platinum Copay NYS OON NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170022-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170035,FlexFit Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170035-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170040,FlexFit Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170040-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1260002,Standard Silver ST OON Dep29 Wellness,18029NY126,,NYN001,NYS001,NYF004,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1260009,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260002-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700.00 ","$1,800.00 ",$0.00 ,$60.00 ,"$1,700.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1483784,18029NY1300014,Standard Bronze ST OON Dep25 FP,18029NY130,,NYN001,NYS001,NYF019,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300014-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310009,Standard Bronze ST OON Dep25 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310009-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310009,Standard Bronze ST OON Dep25 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310009,Standard Bronze ST OON Dep25 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310009-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1483784,18029NY1310010,Standard Bronze ST OON Dep29 Wellness,18029NY131,,NYN001,NYS001,NYF007,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,18029NY1310013,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1310010-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$4,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$4,000.00 ",$60.00 ,$500.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-01,Standard Silver On Exchange Plan,68.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,950 ",$3900 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,900.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,900.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,$0 ,$0 per group,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-03,Limited Cost Sharing Plan Variation,68.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,950 ",$3900 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,900.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,900.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170043,FlexFit Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170043-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170046,FlexFit Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170046-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180077,Choice Plus Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180077-01,Standard Platinum On Exchange Plan,87.22%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$6,450 ",$12900 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,$0 ,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180077,Choice Plus Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180077-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180077,Choice Plus Platinum NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180077-03,Limited Cost Sharing Plan Variation,87.22%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$6,450 ",$12900 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180078,Choice Plus Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180078-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180078,Choice Plus Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180078-03,Limited Cost Sharing Plan Variation,87.22%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$6,450 ",$12900 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200035,iDirect Gold Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200035-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200040,iDirect Gold Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200040-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200043,iDirect Gold Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200043-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200046,iDirect Gold Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200046-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200138,iDirect Gold Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200138-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200141,iDirect Gold Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200141-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200143,iDirect Gold Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200143-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-04,73% AV Level Silver Plan,72.16%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,500.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1483784,18029NY1260012,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY126,,NYN001,NYS001,NYF024,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1260012-05,87% AV Level Silver Plan,86.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,350 ",$4700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0.00 ,"$1,200.00 ",$0.00 ,$60.00 ,$0.00 ,"$1,600.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1170019,FlexFit Platinum Copay NYS OON NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170019-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1180078,Choice Plus Platinum NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY118,,NYN003,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1180078-01,Standard Platinum On Exchange Plan,87.22%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$6,450 ",$12900 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,$0 ,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1200144,iDirect Gold Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200144-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1240046,iDirect Silver Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240046-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1300099,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300099-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1240037,iDirect Silver Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240037-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1240045,iDirect Silver Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240045-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220025,Choice Plus Gold NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220025-01,Standard Gold On Exchange Plan,77.30%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,"$7,350 ",$14700 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220025,Choice Plus Gold NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220025-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220025,Choice Plus Gold NS OON Dep25 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220025-03,Limited Cost Sharing Plan Variation,77.30%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,"$7,350 ",$14700 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220026,Choice Plus Gold NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220026-01,Standard Gold On Exchange Plan,77.30%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,"$7,350 ",$14700 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220026,Choice Plus Gold NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,$0.00 ,$60.00 ,$0.00 ,$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1483784,18029NY1220026,Choice Plus Gold NS OON Dep29 Adult Vision Wellness Nurse Helpline Telemedicine,18029NY122,,NYN003,NYS002,NYF029,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyII_13614_Independent%20Sample%202_0.pdf,18029NY1220026-03,Limited Cost Sharing Plan Variation,77.30%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,"$7,350 ",$14700 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,000.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1240035,iDirect Silver Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240035-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1240040,iDirect Silver Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240040-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1240043,iDirect Silver Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240043-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1300104,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300104-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1300107,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300107-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1483784,18029NY1300110,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300110-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170015,FlexFit Platinum Copay NYS OON NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170015-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170016,FlexFit Platinum Copay NYS OON NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170016-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170018,FlexFit Platinum Copay NYS OON NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170018-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170021,FlexFit Platinum Copay NYS OON NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170021-01,Standard Platinum On Exchange Plan,86.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170033,FlexFit Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170033-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170036,FlexFit Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170036-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170037,FlexFit Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170037-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1170045,FlexFit Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170045-01,Standard Platinum On Exchange Plan,86.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200033,iDirect Gold Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200033-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200036,iDirect Gold Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200036-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200037,iDirect Gold Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200037-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200045,iDirect Gold Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200045-01,Standard Gold On Exchange Plan,76.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200137,iDirect Gold Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200137-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200139,iDirect Gold Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200139-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200140,iDirect Gold Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200140-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1200142,iDirect Gold Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF036,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200142-01,Standard Gold On Exchange Plan,76.05%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$0.00 ,"$2,000.00 ",$60.00 ,"$1,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1240033,iDirect Silver Coinsurance HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240033-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1240036,iDirect Silver Coinsurance HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240036-01,Standard Silver On Exchange Plan,68.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,000.00 ",$0.00 ,"$3,600.00 ",$60.00 ,"$3,000.00 ",$100.00 ,$300.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1483784,18029NY1300122,iDirect Bronze Enhanced HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300122-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1483784,18029NY1300125,iDirect Bronze Enhanced HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300125-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1483784,18029NY1300127,iDirect Bronze Enhanced HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300127-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1483784,18029NY1300128,iDirect Bronze Enhanced HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300128-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1483784,18029NY1300121,iDirect Bronze Enhanced HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300121-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1483784,18029NY1300123,iDirect Bronze Enhanced HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300123-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1483784,18029NY1300124,iDirect Bronze Enhanced HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300124-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1483784,18029NY1300126,iDirect Bronze Enhanced  HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF032,Existing,POS,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300126-01,Standard Bronze On Exchange Plan,64.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,500 ",$7000 per group,30%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,500.00 ",$0.00 ,"$3,100.00 ",$60.00 ,"$3,500.00 ",$0.00 ,"$1,000.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1200178,iDirect Gold Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200178-01,Standard Gold On Exchange Plan,76.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$500.00 ,$0.00 ,$60.00 ,"$1,500.00 ",$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240135,iDirect Silver Blended HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240135-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240136,iDirect Silver Blended HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240136-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240146,iDirect Silver Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240146-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240149,iDirect Silver Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240149-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240150,iDirect Silver Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240150-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240152,iDirect Silver Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240152-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240194,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240194-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240197,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240197-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1300097,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300097-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1300100,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300100-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1300101,iDirect Bronze HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300101-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1483784,18029NY1300109,iDirect Bronze HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF018,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300109-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,150 ",$10300 per group,50%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,"$5,100.00 ",$0.00 ,"$1,500.00 ",$60.00 ,"$5,100.00 ",$0.00 ,$800.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1200181,iDirect Gold Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200181-01,Standard Gold On Exchange Plan,76.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$500.00 ,$0.00 ,$60.00 ,"$1,500.00 ",$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1200183,iDirect Gold Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200183-01,Standard Gold On Exchange Plan,76.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$500.00 ,$0.00 ,$60.00 ,"$1,500.00 ",$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1200184,iDirect Gold Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200184-01,Standard Gold On Exchange Plan,76.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500.00 ",$500.00 ,$0.00 ,$60.00 ,"$1,500.00 ",$600.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240130,iDirect Silver Blended HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240130-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240133,iDirect Silver Blended HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240133-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240199,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240199-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1240200,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240200-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1170066,iShare Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170066-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1170069,iShare Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170069-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1170071,iShare Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170071-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1170072,iShare Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170072-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1200130,iShare Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200130-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1300114,iDirect Bronze MV HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300114-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1300117,iDirect Bronze MV HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300117-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1300119,iDirect Bronze MV HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300119-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,16-1483784,18029NY1300120,iDirect Bronze MV HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300120-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1200177,iDirect Gold Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200177-01,Standard Gold On Exchange Plan,76.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1200179,iDirect Gold Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200179-01,Standard Gold On Exchange Plan,76.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1200180,iDirect Gold Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200180-01,Standard Gold On Exchange Plan,76.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1200182,iDirect Gold Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF013,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200182-01,Standard Gold On Exchange Plan,76.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,100.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$1,200.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240129,iDirect Silver Blended NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240129-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240131,iDirect Silver Blended NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240131-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240132,iDirect Silver Blended NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240132-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240134,iDirect Silver Blended NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF035,New,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240134-01,Standard Silver On Exchange Plan,66.03%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,325 ",$6650 per group,25%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$3,300.00 ",$70.00 ,"$4,000.00 ",$60.00 ,"$3,300.00 ",$800.00 ,$50.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240145,iDirect Silver Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240145-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240147,iDirect Silver Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240147-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240148,iDirect Silver Copay NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240148-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240151,iDirect Silver Copay NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF025,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240151-01,Standard Silver On Exchange Plan,69.06%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,100.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240193,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240193-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240195,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240195-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240196,iDirect Silver Copay HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240196-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1240198,iDirect Silver Copay HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240198-01,Standard Silver On Exchange Plan,67.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,200.00 ","$1,200.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1300113,iDirect Bronze MV HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300113-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1300115,iDirect Bronze MV HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300115-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1300116,iDirect Bronze MV HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300116-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,16-1483784,18029NY1300118,iDirect Bronze MV HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY130,,NYN001,NYS001,NYF011,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1300118-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0%,,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 ,"$6,600.00 ",$0.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1200133,iShare Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200133-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1170100,Choice Plus Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170100-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1170103,Choice Plus Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170103-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1200081,Choice Plus Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200081-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0170001,Fidelis Care Gold ST INN Pediatric Dental Dep29,25303NY017,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0170001-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0200001,Fidelis Care Platinum ST INN Pediatric Dental Dep29,25303NY020,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0200001-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0200001,Fidelis Care Platinum ST INN Pediatric Dental Dep29,25303NY020,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0200001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0200001,Fidelis Care Platinum ST INN Pediatric Dental Dep29,25303NY020,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0200001-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1200135,iShare Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200135-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,16-1483784,18029NY1200136,iShare Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200136-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1170065,iShare Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170065-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1170067,iShare Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170067-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1170068,iShare Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170068-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1170070,iShare Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN001,NYS001,NYF033,New,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170070-01,Standard Platinum On Exchange Plan,89.21%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$20.00 ,"$2,500.00 ",$60.00 ,$0.00 ,$70.00 ,$600.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1200129,iShare Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200129-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1200131,iShare Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200131-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1200132,iShare Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200132-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,16-1483784,18029NY1200134,iShare Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF034,New,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200134-01,Standard Gold On Exchange Plan,76.88%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,40%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$0.00 ,"$7,300.00 ",$60.00 ,$0.00 ,$200.00 ,"$1,200.00 ",$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1170098,Choice Plus Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170098-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1170101,Choice Plus Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170101-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1170102,Choice Plus Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170102-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1170104,Choice Plus Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170104-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1200083,Choice Plus Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200083-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1200088,Choice Plus Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200088-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1200091,Choice Plus Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200091-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1200094,Choice Plus Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200094-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1240067,Choice Plus Silver HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240067-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1240072,Choice Plus Silver HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240072-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1240075,Choice Plus Silver HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240075-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,16-1483784,18029NY1240078,Choice Plus Silver HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240078-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1170097,Choice Plus Platinum NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170097-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1170099,Choice Plus Platinum NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY117,,NYN003,NYS002,NYF010,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1170099-01,Standard Platinum On Exchange Plan,86.20%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,"$6,750 ",$13500 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0.00 ,$500.00 ,$0.00 ,$60.00 ,$0.00 ,$700.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1200084,Choice Plus Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200084-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1200085,Choice Plus Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200085-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1200093,Choice Plus Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN003,NYS002,NYF030,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200093-01,Standard Gold On Exchange Plan,76.35%,,No,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,"$7,550 ",$15100 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300.00 ","$1,100.00 ",$0.00 ,$60.00 ,"$1,300.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1240065,Choice Plus Silver HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240065-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1240068,Choice Plus Silver HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240068-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1240069,Choice Plus Silver HSAQ NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240069-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,16-1483784,18029NY1240077,Choice Plus Silver HSAQ NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN003,NYS002,NYF031,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240077-01,Standard Silver On Exchange Plan,66.74%,,Yes,Yes,Yes,85%,15%,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,"$6,650 ",$13300 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,0%,,,50%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,600.00 ",$200.00 ,"$3,900.00 ",$60.00 ,"$2,600.00 ","$1,000.00 ",$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1200186,Max Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200186-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1200189,Max Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200189-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1200191,Max Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200191-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1200192,Max Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200192-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1240178,Max Silver NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240178-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1240181,Max Silver NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP FP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240181-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1240182,Max Silver NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240182-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,16-1483784,18029NY1240184,Max Silver NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness FP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240184-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1200185,Max Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200185-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1200187,Max Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200187-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1200188,Max Gold NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200188-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1200190,Max Gold NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY120,,NYN001,NYS001,NYF014,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1200190-01,Standard Gold On Exchange Plan,77.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,250 ",$2500 per group,20%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,200.00 ",$800.00 ,$200.00 ,$60.00 ,"$1,200.00 ",$800.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1240177,Max Silver NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240177-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1240179,Max Silver NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240179-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1240180,Max Silver NS OON Dep25 Adult Vision Nurse Helpline Telemedicine Wellness DP,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240180-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,Independent Health Benefits Corporation,18029,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,16-1483784,18029NY1240183,Max Silver NS OON Dep29 Adult Vision Nurse Helpline Telemedicine Wellness,18029NY124,,NYN001,NYS001,NYF017,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency only,Yes,Emergency services covered as in-network; all other services covered at deductible and coinsurance,No,,https://www.independenthealth.com/Exchange/EnrollmentPayment.aspx,,https://fm.formularynavigator.com/MemberPages/pdf/2019DrugFormularyIII_14290_Independent%20Sample%202_0.pdf,18029NY1240183-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,800.00 ","$1,200.00 ",$0.00 ,$60.00 ,"$2,800.00 ",$900.00 ,$0.00 ,$60.00 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0010001,Fidelis Care Bronze ST INN Pediatric Dental Dep25,25303NY001,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0010001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0010001,Fidelis Care Bronze ST INN Pediatric Dental Dep25,25303NY001,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0010001,Fidelis Care Bronze ST INN Pediatric Dental Dep25,25303NY001,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0010001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$2,990 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0020001,Fidelis Care Silver ST INN Pediatric Dental Dep25,25303NY002,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0020001-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$504 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0030001,Fidelis Care Gold ST INN Pediatric Dental Dep25,25303NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0030001-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0030001,Fidelis Care Gold ST INN Pediatric Dental Dep25,25303NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0030001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0030001,Fidelis Care Gold ST INN Pediatric Dental Dep25,25303NY003,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0030001-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0040001,Fidelis Care Platinum ST INN Pediatric Dental Dep25,25303NY004,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0040001-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0040001,Fidelis Care Platinum ST INN Pediatric Dental Dep25,25303NY004,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0040001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0040001,Fidelis Care Platinum ST INN Pediatric Dental Dep25,25303NY004,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0080001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0040001-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0050001,Fidelis Care Bronze for Children Child Only ST INN Pediatric Dental,25303NY005,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0050001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0050001,Fidelis Care Bronze for Children Child Only ST INN Pediatric Dental,25303NY005,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0050001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0050001,Fidelis Care Bronze for Children Child Only ST INN Pediatric Dental,25303NY005,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0050001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$2,990 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0060001,Fidelis Care Silver for Children Child Only ST INN Pediatric Dental,25303NY006,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0060001-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$504 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0070001,Fidelis Care Gold for Children Child Only ST INN Pediatric Dental,25303NY007,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0070001-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0070001,Fidelis Care Gold for Children Child Only ST INN Pediatric Dental,25303NY007,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0070001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0070001,Fidelis Care Gold for Children Child Only ST INN Pediatric Dental,25303NY007,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0070001-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0080001,Fidelis Care Platinum for Children Child Only ST INN Pediatric Dental,25303NY008,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0080001-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0080001,Fidelis Care Platinum for Children Child Only ST INN Pediatric Dental,25303NY008,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0080001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0080001,Fidelis Care Platinum for Children Child Only ST INN Pediatric Dental,25303NY008,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,Yes,Both,Yes,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0080001-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0090001,Fidelis Care Catastrophic ST INN Pediatric Dental,25303NY009,,NYN001,NYS001,NYF004,Existing,HMO,Catastrophic,Yes,Both,Yes,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0090001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,184 ",$0 ,$0 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0110001,Fidelis Care Bronze ST INN Pediatric Dental Dep29,25303NY011,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0110001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0110001,Fidelis Care Bronze ST INN Pediatric Dental Dep29,25303NY011,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0110001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0110001,Fidelis Care Bronze ST INN Pediatric Dental Dep29,25303NY011,,NYN001,NYS001,NYF003,Existing,HMO,Bronze,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0050001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0110001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$2,990 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$2,990 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0140001,Fidelis Care Silver ST INN Pediatric Dental Dep29,25303NY014,,NYN001,NYS001,NYF001,Existing,HMO,Silver,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0060001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0140001-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$504 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0170001,Fidelis Care Gold ST INN Pediatric Dental Dep29,25303NY017,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0170001-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,810 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"New York State Catholic Health Plan, Inc.",25303,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,82-3380290,25303NY0170001,Fidelis Care Gold ST INN Pediatric Dental Dep29,25303NY017,,NYN001,NYS001,NYF001,Existing,HMO,Gold,Yes,Both,Yes,No,,,,,,Allows Adult-Only,25303NY0070001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://members.fideliscare.org/initialpayment,,http://fideliscare.org/pharmacy,25303NY0170001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,11-2480692,30798NY0010003,"Pediatric Dental, ST,INN,DP",30798NY001,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0010003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,11-2480692,30798NY0010004,"Pediatric Dental, ST,INN,DP",30798NY001,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0010004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),Yes,11-2480692,30798NY0020003,"Pediatric Dental, ST,INN,DP",30798NY002,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0020003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),Yes,11-2480692,30798NY0020004,"Pediatric Dental, ST,INN,DP",30798NY002,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0020004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,11-2480692,30798NY0010005,"Family Dental, NS,INN,DP,DEP 29",30798NY001,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0010005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,11-2480692,30798NY0010006,"Family Dental, NS,INN,DP,DEP 29",30798NY001,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0010006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),Yes,11-2480692,30798NY0020005,"Family Dental, NS,INN,DP,DEP 29",30798NY002,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Dentcare Delivery Systems, Inc.",30798,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),Yes,11-2480692,30798NY0020006,"Family Dental, NS,INN,DP,DEP 29",30798NY002,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,30798NY0020006-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480001,"Bronze, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480001,"Bronze, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480001,"Bronze, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480002,"Bronze, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480002-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480002,"Bronze, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480002,"Bronze, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480002-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480003,"Bronze Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480003-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480003,"Bronze Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480003,"Bronze Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480003-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480014,"Silver, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480014-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480026,"Gold, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480026-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-03,Limited Cost Sharing Plan Variation,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-05,87% AV Level Silver Plan,86.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480015,"Silver, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480015-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480016,"Silver Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480026,"Gold, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480026,"Gold, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480026-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480027,"Gold, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480027-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480027,"Gold, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480027-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480027,"Gold, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480027-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480028,"Gold Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480028-01,Standard Gold On Exchange Plan,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480028,"Gold Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480028-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480028,"Gold Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480028-03,Limited Cost Sharing Plan Variation,79.77%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480035,"Platinum, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480035-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480035,"Platinum, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480035-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480035,"Platinum, ST, OON, Dep25",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480035-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480036,"Platinum, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480036-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,16-1105741,36346NY0490002,"Blue Value Dental 1, NS, OON, Dep25, Adult/Family Dental",36346NY049,,NYN001,NYS001,,Existing,PPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bsneny.com/billpay,,,36346NY0490002-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$50 ,$150 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,16-1105741,36346NY0490003,"Blue Value Dental 1, NS, OON, Dep29, Adult/Family Dental",36346NY049,,NYN001,NYS001,,New,PPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bsneny.com/billpay,,,36346NY0490003-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$50 ,$150 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,The Guardian Life Insurance Company,42640,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,13-5123390,42640NY0280001,"Managed DentalGuard NY10 Family Plan, NS, INN, Adult/Family Dental, Dep25, Family Dental",42640NY028,,NYN002,NYS001,,Existing,HMO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.993,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx,,,42640NY0280001-01,Standard Low On Exchange Plan,71.30%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,The Guardian Life Insurance Company,42640,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,13-5123390,42640NY0300001,"Managed DentalGuard NY Child Essentials 2, ST, INN, Pediatric Dental",42640NY030,,NYN002,NYS001,,Existing,HMO,Low,,Both,,,,,,,,Allows Child-Only,,,,0.993,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx,,,42640NY0300001-01,Standard Low On Exchange Plan,71.30%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,The Guardian Life Insurance Company,42640,SBE-PUF,1,3/4/2019 0:00,3,Individual,Yes,13-5123390,42640NY0330001,"Guardian Pediatric Essentials, ST, INN, OON, Pediatric Dental",42640NY033,,NYN001,NYS002,,Existing,PPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Coverage is provided outside of the Service Area.,Yes,,https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx,,,42640NY0330001-01,Standard Low On Exchange Plan,,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$75 ,$150 per group,,,,,$150 ,$300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,The Guardian Life Insurance Company,42640,SBE-PUF,1,3/4/2019 0:00,4,Individual,Yes,13-5123390,42640NY0320001,"Guardian Family Essentials, NS, INN, OON, Adult/Family Dental, Dep 25, Family Dental",42640NY032,,NYN001,NYS002,,Existing,PPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Coverage is provided outside of the Service Area.,Yes,,https://dentalexchange.guardianlife.com/secure/PAWEBSITE.MEMBER.UI/WBSExchangePayment.aspx,,,42640NY0320001-01,Standard Low On Exchange Plan,,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$75 ,$150 per group,,,,,$150 ,$300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,Dentegra Insurance Company of New England,42750,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,30-0318743,42750NY0010001,Dentegra Dental PPO Pediatric Basic Plan ST OON Pediatric Dental Dep 19,42750NY001,,NYN001,NYS001,,Existing,PPO,Low,No,On the Exchange,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Nationwide Network,Yes,,https://www.dentegra.com/hx/checkout,,,42750NY0010001-01,Standard Low On Exchange Plan,70.70%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$65 ,$195 per group,,,,,$65 ,$195 per group,$65 ,$195 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,Dentegra Insurance Company of New England,42750,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,30-0318743,42750NY0010007,Dentegra Dental PPO Family Basic Plan NS OON Family Dental Dep 25,42750NY001,,NYN001,NYS001,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Nationwide Network,Yes,,https://www.dentegra.com/hx/checkout,,,42750NY0010007-01,Standard Low On Exchange Plan,70.70%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$65 ,$195 per group,,,,,$65 ,$195 per group,$65 ,$195 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,23-7391136,44113NY0440004,"Empire Dental Family Value, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS006,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,23-7391136,44113NY0440005,"Empire Dental Family Value, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS005,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540126,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540126-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540128,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540128-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540130,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540130-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540130,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540130-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540131,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540131-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540131,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540131-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540131,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540131-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540132,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540132-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540132,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540132-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540132,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540132-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540133,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540133-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540133,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540133-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540133,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540133-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540136,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540136-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540136,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540136-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540136,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540136-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480036,"Platinum, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480036-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480036,"Platinum, ST, OON, Dep29",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,36346NY0480037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480036-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480037,"Platinum Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480037-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480037,"Platinum Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480037-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,36346NY0480037,"Platinum Child only, ST, OON",36346NY048,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bsneny.com/billpay,,https://www.bsneny.com/nysprescriptions,36346NY0480037-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueShield of Northeastern New York,36346,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,16-1105741,36346NY0490001,"Blue Pediatric Dental, ST, OON, Pediatric Dental",36346NY049,,NYN001,NYS001,,Existing,PPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bsneny.com/billpay,,,36346NY0490001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540126,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540126-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540126,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540126-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540127,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540127-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540127,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540127-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540127,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540127-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540129,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540129-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540130,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 25,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540130-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540137,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540137-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540137,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540137-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540137,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540137-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540143,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540143-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540143,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540143-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540138,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540138-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540139,Empire Gatekeeper X Silver ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540139-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540140,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540140-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540140,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540140-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540140,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540140-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540141,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540141-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540141,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540141-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540141,Empire Gatekeeper X Gold ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540141-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540142,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540142-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540142,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540142-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540142,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540142-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540143,Empire Gatekeeper X Platinum ST INN Pediatric Dental Dep 29,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540143-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540144,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540144-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540144,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540144-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540144,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS002,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540144-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540145,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540145-01,Standard Bronze On Exchange Plan,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540145,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540145-02,Zero Cost Sharing Plan Variation,100.00%,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540145,Empire Gatekeeper X for HSA Bronze ST INN Pediatric Dental Child Only,44113NY054,,NYN003,NYS001,NYF002,New,EPO,Expanded Bronze,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540145-03,Limited Cost Sharing Plan Variation,62.11%,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$0 ,"$4,800 ",$60 ,"$4,300 ","$1,600 ",$600 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,4,Individual,Yes,23-7391136,44113NY0420003,"Empire Dental Pediatric, ST, OON, Pediatric Dental",44113NY042,,NYN001,NYS005,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0420003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450001,"Bronze, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450001,"Bronze, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450001,"Bronze, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450001-03,Limited Cost Sharing Plan Variation,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540146,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540146-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-01,Standard Silver On Exchange Plan,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-03,Limited Cost Sharing Plan Variation,71.98%,0.722050878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,700 ",$3400 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,30.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,700 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-04,73% AV Level Silver Plan,73.99%,0.741997323,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,$0 ,$0 per group,"$1,350 ",$2700 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,25.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,300 ","$2,500 ",$0 ,$60 ,$700 ,"$3,100 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-05,87% AV Level Silver Plan,86.86%,0.872320632,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,$0 ,$0 per group,$250 ,$500 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$900 ,$0 ,$60 ,$250 ,"$1,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540147,Empire Gatekeeper X Silver Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540147-06,94% AV Level Silver Plan,93.94%,0.944020725,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,5.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540148,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540148-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540148,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540148-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540148,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540148-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540149,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540149-01,Standard Gold On Exchange Plan,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540149,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540149-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540149,Empire Gatekeeper X Gold Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF004,New,EPO,Gold,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540149-03,Limited Cost Sharing Plan Variation,79.77%,0.799020234,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$600 ,$1200 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,20.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,800 ",$0 ,$60 ,$600 ,"$2,900 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540150,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540150-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540150,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540150-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540150,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540150-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540151,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540151-01,Standard Platinum On Exchange Plan,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540151,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540151-02,Zero Cost Sharing Plan Variation,100.00%,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,23-7391136,44113NY0540151,Empire Gatekeeper X Platinum Child Only ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF003,New,EPO,Platinum,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540151-03,Limited Cost Sharing Plan Variation,88.01%,0.883560691,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,10.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,000 ",$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,23-7391136,44113NY0440001,"Empire Dental Family, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS006,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,23-7391136,44113NY0440003,"Empire Dental Family, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS005,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,23-7391136,44113NY0540134,Empire Gatekeeper Catastrophic ST INN Pediatric Dental,44113NY054,,NYN003,NYS002,NYF001,New,EPO,Catastrophic,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540134-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,200 ",$0 ,$0 ,$60 
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,23-7391136,44113NY0540135,Empire Gatekeeper Catastrophic ST INN Pediatric Dental,44113NY054,,NYN003,NYS001,NYF001,New,EPO,Catastrophic,Yes,Both,No,Yes,All specialists require referral with the exception of OB/GYN.,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,1/1/2019,12/31/2019,No,Emergency Coverage Only,No,TRAD/PAR network,No,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,https://www.empireblue.com/EBCSelectdrugtier3,44113NY0540135-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,7200,0,0,60
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,3,Individual,Yes,23-7391136,44113NY0440051,"Empire Dental Family Enhanced, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS006,,Existing,PPO,High,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,0.852,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440051-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$0 ,per group not applicable,,,,,$0 ,per group not applicable,$0 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,3,Individual,Yes,23-7391136,44113NY0440052,"Empire Dental Family Enhanced, NS, OON, Adult/Family Dental, Dep25",44113NY044,,NYN001,NYS005,,Existing,PPO,High,,On the Exchange,,,,,,,,Allows Adult and Child-Only,,,,0.852,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0440052-01,Standard High On Exchange Plan,85.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$0 ,per group not applicable,,,,,$0 ,per group not applicable,$0 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Empire HealthChoice Assurance, Inc.",44113,SBE-PUF,1,3/4/2019 0:00,4,Individual,Yes,23-7391136,44113NY0420001,"Empire Dental Pediatric, ST, OON, Pediatric Dental",44113NY042,,NYN001,NYS006,,Existing,PPO,Low,,On the Exchange,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,Yes,Out of Country covered services are reimbursed as out-of-network benefits.,Yes,"If a member does not use a network dentist, services will be reimbursed at the out-of-network level.",Yes,,https://payment.anthem.com/sales/payment/shopper/home?state=NY,,,44113NY0420001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$25 ,per group not applicable,,,,,$25 ,per group not applicable,$25 ,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450002,"Bronze, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450002,"Bronze, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650016,"Ind Focus, Platinum, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650016-01,Standard Platinum On Exchange Plan,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650016,"Ind Focus, Platinum, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010003,UHC Compass Gold ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010003-03,Limited Cost Sharing Plan Variation,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010004,UHC Compass Gold ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010004-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010004,UHC Compass Gold ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010004,UHC Compass Gold ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010004-03,Limited Cost Sharing Plan Variation,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,155 ",$12310 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,$700 ,$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-05,87% AV Level Silver Plan,87.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$700 ,$1400 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$40 ,"$1,100 ",$60 ,$300 ,"$1,500 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-06,94% AV Level Silver Plan,95.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150 ",$2300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$30 ,$600 ,$60 ,$0 ,"$1,100 ",$20 ,$30 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450002,"Bronze, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450003,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450002-03,Limited Cost Sharing Plan Variation,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450003,"Bronze Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450003-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450003,"Bronze Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450003,"Bronze Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450003-03,Limited Cost Sharing Plan Variation,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$5,880 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-04,73% AV Level Silver Plan,72.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-05,87% AV Level Silver Plan,86.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450014,"Silver, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450014-06,94% AV Level Silver Plan,93.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-04,73% AV Level Silver Plan,72.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-05,87% AV Level Silver Plan,86.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450015,"Silver, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450016,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450015-06,94% AV Level Silver Plan,93.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-01,Standard Silver On Exchange Plan,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-03,Limited Cost Sharing Plan Variation,70.30%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$3,010 ",$0 ,$60 ,"$1,700 ","$1,905 ",$518 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-04,73% AV Level Silver Plan,72.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$3,010 ",$0 ,$60 ,"$1,350 ","$1,905 ",$432 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-05,87% AV Level Silver Plan,86.09%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,201 ",$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450016,"Silver Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450016-06,94% AV Level Silver Plan,93.51%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$674 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450026,"Gold, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450026-01,Standard Gold On Exchange Plan,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450026,"Gold, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450026,"Gold, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450026-03,Limited Cost Sharing Plan Variation,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450027,"Gold, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450027-01,Standard Gold On Exchange Plan,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450027,"Gold, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450027-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450027,"Gold, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450028,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450027-03,Limited Cost Sharing Plan Variation,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450028,"Gold Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450028-01,Standard Gold On Exchange Plan,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450028,"Gold Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450028-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450028,"Gold Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF002,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450028-03,Limited Cost Sharing Plan Variation,78.62%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$2,235 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450035,"Platinum, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450035-01,Standard Platinum On Exchange Plan,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450035,"Platinum, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450035-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450035,"Platinum, ST, OON, Dep25",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450035-03,Limited Cost Sharing Plan Variation,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450036,"Platinum, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450036-01,Standard Platinum On Exchange Plan,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450036,"Platinum, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450036-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450036,"Platinum, ST, OON, Dep29",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,49526NY0450037,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450036-03,Limited Cost Sharing Plan Variation,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450037,"Platinum Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450037-01,Standard Platinum On Exchange Plan,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450037,"Platinum Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450037-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,16-1105741,49526NY0450037,"Platinum Child only, ST, OON",49526NY045,,NYN001,NYS001,NYF001,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450037-03,Limited Cost Sharing Plan Variation,87.23%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,455 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,16-1105741,49526NY0460001,"Blue Pediatric Dental, ST, OON, Pediatric Dental",49526NY046,,NYN001,NYS001,,Existing,PPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bcbswny.com/billpay,,,49526NY0460001-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450029,"Ind align, Gold, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450029-01,Standard Gold On Exchange Plan,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450029,"Ind align, Gold, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450029-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450029,"Ind align, Gold, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450029-03,Limited Cost Sharing Plan Variation,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450030,"Ind align, Gold, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450030-01,Standard Gold On Exchange Plan,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450030,"Ind align, Gold, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450030-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450030,"Ind align, Gold, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450030-03,Limited Cost Sharing Plan Variation,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450038,"Ind align, Platinum, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450038-01,Standard Platinum On Exchange Plan,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450038,"Ind align, Platinum, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450038-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450038,"Ind align, Platinum, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450038-03,Limited Cost Sharing Plan Variation,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450039,"Ind align, Platinum, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450039-01,Standard Platinum On Exchange Plan,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450039,"Ind align, Platinum, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450039-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0450039,"Ind align, Platinum, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450039-03,Limited Cost Sharing Plan Variation,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,16-1105741,49526NY0460002,"Blue Value Dental 1, NS, OON, Dep25, Adult/Family Dental",49526NY046,,NYN001,NYS001,,Existing,PPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bcbswny.com/billpay,,,49526NY0460002-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$50 ,$150 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,16-1105741,49526NY0460003,"Blue Value Dental 1, NS, OON, Dep29, Adult/Family Dental",49526NY046,,NYN001,NYS001,,New,PPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,Yes,Pays in-network Participating provider allowed amount,No,,https://www.bcbswny.com/billpay,,,49526NY0460003-01,Standard Low On Exchange Plan,68.40%,,,,No,100%,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,$350 ,$700 per group,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,$50 ,$150 per group,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650005,"Ind align, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650005-01,Standard Bronze On Exchange Plan,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650005,"Ind align, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650005-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650005,"Ind align, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650005-03,Limited Cost Sharing Plan Variation,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650006,"Ind align, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650006-01,Standard Bronze On Exchange Plan,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650006,"Ind align, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650006,"Ind align, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650006-03,Limited Cost Sharing Plan Variation,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650007,"Ind Focus, Gold, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650007-01,Standard Gold On Exchange Plan,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650007,"Ind Focus, Gold, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650007,"Ind Focus, Gold, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650007-03,Limited Cost Sharing Plan Variation,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650008,"Ind Focus, Gold, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650008-01,Standard Gold On Exchange Plan,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650008,"Ind Focus, Gold, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650008,"Ind Focus, Gold, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF004,Existing,POS,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650008-03,Limited Cost Sharing Plan Variation,76.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$2,480 ",$0 ,$60 ,$500 ,"$1,710 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650011,"Ind Focus, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650011-01,Standard Bronze On Exchange Plan,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650011,"Ind Focus, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650011-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650011,"Ind Focus, Bronze, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650011-03,Limited Cost Sharing Plan Variation,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650012,"Ind Focus, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650012-01,Standard Bronze On Exchange Plan,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650012,"Ind Focus, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650012,"Ind Focus, Bronze, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF006,Existing,POS,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650012-03,Limited Cost Sharing Plan Variation,58.60%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,50.00%,,,0.00%,"$7,900 ",$15800 per group,Not Applicable,per group not applicable,"$1,720 ",$0 ,"$6,180 ",$60 ,"$3,541 ",$465 ,"$3,254 ",$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650016,"Ind Focus, Platinum, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650016-03,Limited Cost Sharing Plan Variation,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650017,"Ind Focus, Platinum, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650017-01,Standard Platinum On Exchange Plan,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650017,"Ind Focus, Platinum, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650017-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,16-1105741,49526NY0650017,"Ind Focus, Platinum, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF003,Existing,POS,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650017-03,Limited Cost Sharing Plan Variation,86.90%,,No,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,"$7,900 ",$15800 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,50.00%,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,0.00%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,240 ",$0 ,$60 ,$0 ,$985 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-04,73% AV Level Silver Plan,72.03%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$5,000 ",$10000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500 ","$2,690 ",$0 ,$60 ,"$1,500 ","$2,280 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,"$1,500 ",$3000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$500 ,"$1,000 ",$0 ,$60 ,$500 ,"$1,000 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450017,"Ind align, Silver, NS, OON, Dep25, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450017-06,94% AV Level Silver Plan,94.75%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500 ,$1000 per group,$500 ,$1000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$500 ,$0 ,$60 ,$0 ,$500 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-04,73% AV Level Silver Plan,72.03%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$5,000 ",$10000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500 ","$2,690 ",$0 ,$60 ,"$1,500 ","$2,280 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,"$1,500 ",$3000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$500 ,"$1,000 ",$0 ,$60 ,$500 ,"$1,000 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0450018,"Ind align, Silver, NS, OON, Dep29, tiered benefit",49526NY045,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0450018-06,94% AV Level Silver Plan,94.75%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500 ,$1000 per group,$500 ,$1000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$500 ,$0 ,$60 ,$0 ,$500 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-04,73% AV Level Silver Plan,72.03%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$5,000 ",$10000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500 ","$2,690 ",$0 ,$60 ,"$1,500 ","$2,280 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,"$1,500 ",$3000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$500 ,"$1,000 ",$0 ,$60 ,$500 ,"$1,000 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650009,"Ind Focus, Silver, NS, OON, Dep25, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650009-06,94% AV Level Silver Plan,94.75%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500 ,$1000 per group,$500 ,$1000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$500 ,$0 ,$60 ,$0 ,$500 ,$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,0.00%,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,"$6,100 ",$12200 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$2,000 ","$2,850 ",$0 ,$60 ,"$2,000 ","$2,100 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-04,73% AV Level Silver Plan,72.03%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,"$5,000 ",$10000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$1,500 ","$2,690 ",$0 ,$60 ,"$1,500 ","$2,280 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-05,87% AV Level Silver Plan,86.70%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,"$1,500 ",$3000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$500 ,"$1,000 ",$0 ,$60 ,$500 ,"$1,000 ",$0 ,$55 
2019,NY,BlueCross BlueShield of Western New York,49526,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,16-1105741,49526NY0650010,"Ind Focus, Silver, NS, OON, Dep29, tiered benefit",49526NY065,,NYN001,NYS002,NYF005,Existing,POS,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,"Asthma, Heart Disease, Diabetes, Low Back Pain",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Out of Service Area providers available at a higher cost share,No,,https://www.bcbswny.com/billpay,,https://www.bcbswny.com/nysprescriptions,49526NY0650010-06,94% AV Level Silver Plan,94.75%,,Yes,Yes,Yes,95%,5%,,,,,,,,,,,,,,,,,$500 ,$1000 per group,$500 ,$1000 per group,"$10,000 ",$20000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,50.00%,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$500 ,$0 ,$60 ,$0 ,$500 ,$0 ,$55 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010033,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010033-01,Standard Bronze On Exchange Plan,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010033,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010033-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010033,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010033-03,Limited Cost Sharing Plan Variation,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010034,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010034-01,Standard Bronze On Exchange Plan,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010034,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010034-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010034,UHC Compass HSA Bronze NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010035,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010034-03,Limited Cost Sharing Plan Variation,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010035,UHC Compass HSA Bronze NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010035-01,Standard Bronze On Exchange Plan,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010035,UHC Compass HSA Bronze NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010035-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,06-1172891,54235NY0010035,UHC Compass HSA Bronze NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Expanded Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010035-03,Limited Cost Sharing Plan Variation,62.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$60 ,"$5,500 ",$300 ,$60 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010001,UHC Compass Platinum ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010001-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010001,UHC Compass Platinum ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010001-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010001,UHC Compass Platinum ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010001-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010002,UHC Compass Platinum ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010002-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010002,UHC Compass Platinum ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010002,UHC Compass Platinum ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010019,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010002-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010003,UHC Compass Gold ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010003-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010003,UHC Compass Gold ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010021,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010003-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-03,Limited Cost Sharing Plan Variation,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-04,73% AV Level Silver Plan,73.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300 ","$2,000 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-05,87% AV Level Silver Plan,86.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$200 ,$700 ,$0 ,$60 ,$200 ,"$1,100 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010005,UHC Compass Silver ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010005-06,94% AV Level Silver Plan,93.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$60 ,$0 ,$800 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-03,Limited Cost Sharing Plan Variation,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-04,73% AV Level Silver Plan,73.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300 ","$2,000 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-05,87% AV Level Silver Plan,86.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$200 ,$700 ,$0 ,$60 ,$200 ,"$1,100 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010006,UHC Compass Silver ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010023,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010006-06,94% AV Level Silver Plan,93.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$60 ,$0 ,$800 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010013,UHC Compass Bronze ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010013-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010013,UHC Compass Bronze ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010013-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010013,UHC Compass Bronze ST INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010013-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010014,UHC Compass Bronze ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010014-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010014,UHC Compass Bronze ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010014,UHC Compass Bronze ST INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010025,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010014-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010015,UHC Compass Catastrophic ST INN Pediatric Dental,54235NY001,,NYN001,NYS001,NYF005,Existing,HMO,Catastrophic,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010015-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,000 ",$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010019,UHC Compass Platinum ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010019-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010019,UHC Compass Platinum ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010019-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010019,UHC Compass Platinum ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010019-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$60 ,$0 ,"$1,400 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010021,UHC Compass Gold ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010021-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010021,UHC Compass Gold ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010021-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010021,UHC Compass Gold ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010021-03,Limited Cost Sharing Plan Variation,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,500 ",$0 ,$60 ,$600 ,"$1,300 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-01,Standard Silver On Exchange Plan,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-03,Limited Cost Sharing Plan Variation,71.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,900 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-04,73% AV Level Silver Plan,73.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,300 ","$2,000 ",$0 ,$60 ,"$1,000 ","$1,000 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-05,87% AV Level Silver Plan,86.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$200 ,$700 ,$0 ,$60 ,$200 ,"$1,100 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010023,UHC Compass Silver ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010023-06,94% AV Level Silver Plan,93.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$60 ,$0 ,$800 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010025,UHC Compass Bronze ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010025-01,Standard Bronze On Exchange Plan,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010025,UHC Compass Bronze ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010025-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,06-1172891,54235NY0010025,UHC Compass Bronze ST INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010025-03,Limited Cost Sharing Plan Variation,61.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$500 ,$200 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,155 ",$12310 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,$700 ,$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-05,87% AV Level Silver Plan,87.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$700 ,$1400 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$40 ,"$1,100 ",$60 ,$300 ,"$1,500 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010030,UHC Compass Silver NS INN Pediatric Dental Dep 25,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010030-06,94% AV Level Silver Plan,95.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150 ",$2300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$30 ,$600 ,$60 ,$0 ,"$1,100 ",$20 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,155 ",$12310 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,$700 ,$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-05,87% AV Level Silver Plan,87.90%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$700 ,$1400 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$40 ,"$1,100 ",$60 ,$300 ,"$1,500 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010031,UHC Compass Silver NS INN Pediatric Dental Dep 29,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Adult-Only,54235NY0010032,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010031-06,94% AV Level Silver Plan,95.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,150 ",$2300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$30 ,$600 ,$60 ,$0 ,"$1,100 ",$20 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$30 
2019,NY,"UnitedHealthcare of New York, Inc.",54235,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,06-1172891,54235NY0010032,UHC Compass Silver NS INN Pediatric Dental Child Only,54235NY001,,NYN001,NYS001,NYF004,Existing,HMO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",0,,,,Allows Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://uhcexchangebilling.com,,https://www.uhc.com/xnydruglist2019,54235NY0010032-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,550 ",$15100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$11000 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$5,500 ",$0 ,"$2,100 ",$60 ,$300 ,"$1,600 ",$0 ,$30 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160019,"MVP HMO Silver 12, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160019-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160020,"MVP HMO Silver 12, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160020-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160021,"MVP HMO Gold 10, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160021-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160022,"MVP HMO Gold 10, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160022-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140016,"MVP Premier Platinum, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140016-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140016,"MVP Premier Platinum, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140016-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140016,"MVP Premier Platinum, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140016-03,Limited Cost Sharing Plan Variation,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140017,"MVP Premier Platinum, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140017-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140017,"MVP Premier Platinum, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140017-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140017,"MVP Premier Platinum, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190008,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140017-03,Limited Cost Sharing Plan Variation,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160023,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160023-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0160024,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FP",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160024-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170012,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áDP, FPá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170012-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170014,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170014-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170038,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170038-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170041,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170041-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,150 ",$0 ,"$3,200 ",$70 ,"$1,400 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170087,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170087-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,14-1640868,56184NY0170088,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170088-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1640868,56184NY0220002,"MVP Secure Catastrophic, ST, INN, Dep25, Telemedicine, Wellness",56184NY022,,NYN001,NYS001,NYF001,Existing,HMO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0220002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-03,Limited Cost Sharing Plan Variation,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-04,73% AV Level Silver Plan,,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,700 ",$0 ,$90 ,"$1,350 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-05,87% AV Level Silver Plan,,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$400 ,$0 ,$70 ,$250 ,"$1,200 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140012,"MVP Premier Silver, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140012-06,94% AV Level Silver Plan,,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$900 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-03,Limited Cost Sharing Plan Variation,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-04,73% AV Level Silver Plan,,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,700 ",$0 ,$90 ,"$1,350 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-05,87% AV Level Silver Plan,,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$400 ,$0 ,$70 ,$250 ,"$1,200 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140013,"MVP Premier Silver, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190006,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140013-06,94% AV Level Silver Plan,,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$900 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140014,"MVP Premier Gold, ST, INN, Dep25, Telemedicine, Wellnessá",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140014-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140014,"MVP Premier Gold, ST, INN, Dep25, Telemedicine, Wellnessá",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140014-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140014,"MVP Premier Gold, ST, INN, Dep25, Telemedicine, Wellnessá",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140014-03,Limited Cost Sharing Plan Variation,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140015,"MVP Premier Gold, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140015-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140015,"MVP Premier Gold, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140015,"MVP Premier Gold, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190007,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140015-03,Limited Cost Sharing Plan Variation,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140030,"MVP Premier Bronze 2, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140030-01,Standard Bronze On Exchange Plan,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140030,"MVP Premier Bronze 2, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140030-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140030,"MVP Premier Bronze 2, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140030-03,Limited Cost Sharing Plan Variation,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190008,"MVP Premier Platinum, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190008-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190008,"MVP Premier Platinum, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190008-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190008,"MVP Premier Platinum, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF002,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190008-03,Limited Cost Sharing Plan Variation,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190013,"MVP Premier Bronze 2, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190013-01,Standard Bronze On Exchange Plan,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190013,"MVP Premier Bronze 2, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190013-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190013,"MVP Premier Bronze 2, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190013-03,Limited Cost Sharing Plan Variation,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140010,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140010-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140010,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140010-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140010,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140010-03,Limited Cost Sharing Plan Variation,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140031,"MVP Premier Bronze 2, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140031-01,Standard Bronze On Exchange Plan,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140031,"MVP Premier Bronze 2, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140031-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0140031,"MVP Premier Bronze 2, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190013,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140031-03,Limited Cost Sharing Plan Variation,,0.619927253,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$3,300 ",$70 ,"$4,000 ",$0 ,"$1,800 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160051,"MVP HMO Silver 12, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160051-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160052,"MVP HMO Silver 12, INN, Peditric Dental,  Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160052-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160053,"MVP HMO Gold 10, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Adult Vision, Preferred Facility, Telemedicine, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160053-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160054,"MVP HMO Gold 10, INN, Peditric Denta, Dep29, Adult Vision, Acupuncture,  Preferred Facility, Telemedicine, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160054-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160055,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160055-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0160056,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160056-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170026,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170026-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170028,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170028-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170040,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture,  Preferred Facility, Telemedicine, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170040-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170042,"MVP HMO Bronze 1, INN, Pediatric Denta, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170042-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170089,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170089-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,14-1640868,56184NY0170090,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170090-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-03,Limited Cost Sharing Plan Variation,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-04,73% AV Level Silver Plan,,0.739930423,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,650 ","$1,600 ",$0 ,$90 ,"$1,650 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-05,87% AV Level Silver Plan,,0.868633502,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$400 ,$0 ,$70 ,$250 ,"$1,200 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190006,"MVP Premier Silver, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190006-06,94% AV Level Silver Plan,,0.939376556,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$900 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190007,"MVP Premier Gold, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190007-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190007,"MVP Premier Gold, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190007-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1640868,56184NY0190007,"MVP Premier Gold, Child Only, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF003,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190007-03,Limited Cost Sharing Plan Variation,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140011,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140011-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140011,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140011-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0140011,"MVP Premier HDHP Bronze 1, Expanded Bronze, HSA, ST, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190005,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140011-03,Limited Cost Sharing Plan Variation,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1640868,56184NY0170008,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170008-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1640868,56184NY0170010,"MVP HMO Gold 1, INN, Pediatric Denta,l Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170010-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1640868,56184NY0170029,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170029-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0210005,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210005-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0210006,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug,Telemedicine, Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210006-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0210014,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210014-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1640868,56184NY0170035,"MVP HMO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170035-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0190005,"MVP Premier HDHP Bronze 1, Child Only, Expanded Bronze, HSA, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190005-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0190005,"MVP Premier HDHP Bronze 1, Child Only, Expanded Bronze, HSA, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1640868,56184NY0190005,"MVP Premier HDHP Bronze 1, Child Only, Expanded Bronze, HSA, ST, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF004,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190005-03,Limited Cost Sharing Plan Variation,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140034,"MVP Premier Gold 2, ST3PCP, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140034-01,Standard Gold On Exchange Plan,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140034,"MVP Premier Gold 2, ST3PCP, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140034-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140034,"MVP Premier Gold 2, ST3PCP, INN, Dep25, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140034-03,Limited Cost Sharing Plan Variation,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140035,"MVP Premier Gold 2, ST3PCP, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140035-01,Standard Gold On Exchange Plan,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140035,"MVP Premier Gold 2, ST3PCP, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140035-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0140035,"MVP Premier Gold 2, ST3PCP, INN, Dep29, Telemedicine, Wellness",56184NY014,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,56184NY0190015,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0140035-03,Limited Cost Sharing Plan Variation,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1640868,56184NY0170022,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170022-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1640868,56184NY0170024,"MVP HMO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170024-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1640868,56184NY0170030,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision,  Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170030-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1640868,56184NY0170036,"MVP HMO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,á3PCP, DP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170036-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0190015,"MVP Premier Gold 2, Child Only, ST3PCP, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190015-01,Standard Gold On Exchange Plan,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0190015,"MVP Premier Gold 2, Child Only, ST3PCP, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190015-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1640868,56184NY0190015,"MVP Premier Gold 2, Child Only, ST3PCP, INN, Telemedicine, Wellness",56184NY019,,NYN001,NYS001,NYF012,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0190015-03,Limited Cost Sharing Plan Variation,,0.79522194,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$650 ,$1300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$650 ,"$1,200 ",$0 ,$70 ,$650 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0160017,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25,  Adult Vision, Acupuncture, Preferred Facility, Preventive Drug,Telemedicine, Wellness, DP, FPáá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160017-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0160018,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29,  Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP, FPá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160018-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200004,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200004-01,Standard Bronze On Exchange Plan,,0.618792268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200004,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200004-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200004,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200004-03,Limited Cost Sharing Plan Variation,,0.618792268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200007,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200007-01,Standard Bronze On Exchange Plan,,0.618792268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200007,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200007-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1640868,56184NY0200007,"MVP Premier Plus HDHP Bronze 3, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200007-03,Limited Cost Sharing Plan Variation,,0.618792268,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,14-1640868,56184NY0210015,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210015-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150008,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150008-01,Standard Bronze On Exchange Plan,,0.64315016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$0 ,"$2,100 ",$60 ,"$5,100 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150008,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150008,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150008-03,Limited Cost Sharing Plan Variation,,0.64315016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$0 ,"$2,100 ",$60 ,"$5,100 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-01,Standard Silver On Exchange Plan,,0.699991779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,645 ",$5290 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,645 ",$100 ,"$1,300 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-03,Limited Cost Sharing Plan Variation,,0.699991779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,645 ",$5290 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,645 ",$100 ,"$1,300 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-04,73% AV Level Silver Plan,,0.739333743,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,900 ",$3800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$100 ,"$1,500 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-05,87% AV Level Silver Plan,,0.868223541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$30 ,"$1,700 ",$80 ,$350 ,$600 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0210012,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210012-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0210017,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness,áDP",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210017-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150009,"MVP Premier Plus Silver 2, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150009-06,94% AV Level Silver Plan,,0.935420802,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300 ",$2600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$50 ,$100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$50 ,$30 ,"$1,200 ",$60 ,$50 ,$600 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150010,"MVP Premier Plus Gold 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150010-01,Standard Gold On Exchange Plan,,0.776870325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$950 ,$1900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$950 ,$700 ,$0 ,$70 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150010,"MVP Premier Plus Gold 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150010-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150010,"MVP Premier Plus Gold 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150010-03,Limited Cost Sharing Plan Variation,,0.776870325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$950 ,$1900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$950 ,$700 ,$0 ,$70 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150015,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150015-01,Standard Bronze On Exchange Plan,,0.64315016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$0 ,"$2,100 ",$60 ,"$5,100 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150015,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150015-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150015,"MVP Premier Plus Bronze 2, Expanded Bronze, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness, 3PCP",56184NY015,,NYN001,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150015-03,Limited Cost Sharing Plan Variation,,0.64315016,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$0 ,"$2,100 ",$60 ,"$5,100 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-01,Standard Silver On Exchange Plan,,0.699991779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,645 ",$5290 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,645 ",$100 ,"$1,300 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-03,Limited Cost Sharing Plan Variation,,0.699991779,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,645 ",$5290 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,645 ",$100 ,"$1,300 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-04,73% AV Level Silver Plan,,0.739333743,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,900 ",$3800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,900 ",$100 ,"$1,500 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-05,87% AV Level Silver Plan,,0.868223541,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$30 ,"$1,700 ",$80 ,$350 ,$600 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150017,"MVP Premier Plus Silver 2, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF010,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150017-06,94% AV Level Silver Plan,,0.935420802,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,300 ",$2600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$50 ,$100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$50 ,$30 ,"$1,200 ",$60 ,$50 ,$600 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150018,"MVP Premier Plus Gold 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150018-01,Standard Gold On Exchange Plan,,0.776870325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$950 ,$1900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$950 ,$700 ,$0 ,$70 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150018,"MVP Premier Plus Gold 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150018-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150018,"MVP Premier Plus Gold 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150018-03,Limited Cost Sharing Plan Variation,,0.776870325,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$950 ,$1900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$950 ,$700 ,$0 ,$70 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-01,Standard Silver On Exchange Plan,,0.708189131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,400 ",$100 ,"$1,200 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-03,Limited Cost Sharing Plan Variation,,0.708189131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,400 ",$100 ,"$1,200 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-04,73% AV Level Silver Plan,,0.728410758,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$100 ,$0 ,$90 ,$0 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-05,87% AV Level Silver Plan,,0.875702191,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$400 ,$0 ,$70 ,$0 ,"$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150092,"MVP Premier Plus Silver 11, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150092-06,94% AV Level Silver Plan,,0.948365304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$30 ,$0 ,$70 ,$0 ,$500 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-01,Standard Silver On Exchange Plan,,0.708189131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,850 ",$100 ,$0 ,$90 ,$0 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-03,Limited Cost Sharing Plan Variation,,0.708189131,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,850 ",$11700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,850 ",$100 ,$0 ,$90 ,$0 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-04,73% AV Level Silver Plan,,0.728410758,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,100 ",$100 ,$0 ,$90 ,$0 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-05,87% AV Level Silver Plan,,0.875702191,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$400 ,$0 ,$70 ,$0 ,"$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,14-1640868,56184NY0150093,"MVP Premier Plus Silver 11, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness,á3PCP",56184NY015,,NYN001,NYS001,NYF011,New,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150093-06,94% AV Level Silver Plan,,0.948365304,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$30 ,$0 ,$70 ,$0 ,$500 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0160049,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug,Telemedicine, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160049-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0160050,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DP",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160050-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0210011,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DPáá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210011-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,14-1640868,56184NY0210018,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drug, Telemedicine, Wellness, DPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210018-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150012,"MVP Premier Plus Bronze 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150012-01,Standard Bronze On Exchange Plan,,0.619651528,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$9600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,800 ","$1,500 ",$0 ,$70 ,"$1,500 ","$1,300 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150012,"MVP Premier Plus Bronze 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150012-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150012,"MVP Premier Plus Bronze 1, NS, INN, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150012-03,Limited Cost Sharing Plan Variation,,0.619651528,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$9600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,800 ","$1,500 ",$0 ,$70 ,"$1,500 ","$1,300 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150021,"MVP Premier Plus Bronze 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150021-01,Standard Bronze On Exchange Plan,,0.619651528,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$9600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,800 ","$1,500 ",$0 ,$70 ,"$1,500 ","$1,300 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150021,"MVP Premier Plus Bronze 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150021-02,Zero Cost Sharing Plan Variation,,1,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,14-1640868,56184NY0150021,"MVP Premier Plus Bronze 1, NS, INN, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Wellness",56184NY015,,NYN001,NYS001,NYF009,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0150021-03,Limited Cost Sharing Plan Variation,,0.619651528,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$9600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,800 ","$1,500 ",$0 ,$70 ,"$1,500 ","$1,300 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160089,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160089-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160090,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160090-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160093,"MVP HMO Gold 10, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160093-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160094,"MVP HMO Gold 10, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160094-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160097,"MVP HMO Silver 12, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160097-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0160098,"MVP HMO Silver 12, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160098-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170071,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170071-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170072,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170072-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170079,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170079-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170080,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170080-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170091,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170091-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,14-1640868,56184NY0170092,"MVP HMO Bronze 10, INN,  Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170092-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160091,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160091-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160092,"MVP HMO Platinum 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",56184NY016,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160092-01,Standard Platinum On Exchange Plan,,0.88009263,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$700 ,$0 ,$70 ,$0 ,"$1,300 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160095,"MVP HMO Gold 10, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160095-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160096,"MVP HMO Gold 10, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160096-01,Standard Gold On Exchange Plan,,0.797761647,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,200 ",$0 ,$70 ,$600 ,"$1,600 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160099,"MVP HMO Silver 12, INN, Peditric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160099-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0160100,"MVP HMO Silver 12, INN, Peditric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY016,,NYN002,NYS001,NYF002,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160100-01,Standard Silver On Exchange Plan,,0.719894641,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,600 ",$0 ,$90 ,"$1,700 ","$1,500 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170073,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170073-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170074,"MVP HMO Platinum 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF,Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF004,Existing,HMO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170074-01,Standard Platinum On Exchange Plan,,0.86915508,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,400 ",$4800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$0 ,"$1,000 ",$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170081,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170081-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170082,"MVP HMO Bronze 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY017,,NYN002,NYS001,NYF008,Existing,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170082-01,Standard Bronze On Exchange Plan,,0.617194958,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,550 ",$9100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,550 ",$0 ,"$3,100 ",$70 ,"$1,500 ","$1,200 ",$0 ,"$1,000 "
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170093,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170093-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,14-1640868,56184NY0170094,"MVP HMO Bronze 10, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY017,,NYN002,NYS001,NYF009,New,HMO,Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170094-01,Standard Bronze On Exchange Plan,,0.585388465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,600 ",$0 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200032,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellnessá",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200032-01,Standard Gold On Exchange Plan,,0.770199497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600 ",$11200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$10 ,"$1,900 ",$70 ,"$1,350 ",$0 ,"$1,200 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200032,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellnessá",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200032-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200032,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellnessá",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200032-03,Limited Cost Sharing Plan Variation,,0.770199497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600 ",$11200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$10 ,"$1,900 ",$70 ,"$1,350 ",$0 ,"$1,200 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200033,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200033-01,Standard Gold On Exchange Plan,,0.770199497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600 ",$11200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$10 ,"$1,900 ",$70 ,"$1,350 ",$0 ,"$1,300 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,14-1640868,56184NY0170086,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170086-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0160101,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DP, FP",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160101-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,100 ",$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0160102,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DP, FPáá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160102-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,$100 ,$70 ,"$5,500 ",$0 ,"$1,000 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0210031,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF,Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210031-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200033,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200033-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,14-1640868,56184NY0200033,"MVP Premier Plus HDHP Gold National, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, National Network, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF008,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200033-03,Limited Cost Sharing Plan Variation,,0.770199497,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,600 ",$11200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$10 ,"$1,900 ",$70 ,"$1,350 ",$0 ,"$1,300 ",$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,14-1640868,56184NY0170075,"MVP HMO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170075-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,14-1640868,56184NY0170076,"MVP HMO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170076-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,14-1640868,56184NY0170083,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170083-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,14-1640868,56184NY0170084,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness,á3PCP, DP, FP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170084-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-01,Standard Silver On Exchange Plan,,0.701719513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$600 ,$0 ,$90 ,"$2,500 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-03,Limited Cost Sharing Plan Variation,,0.701719513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$600 ,$0 ,$90 ,"$2,500 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-04,73% AV Level Silver Plan,,0.73446465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$600 ,$0 ,$70 ,"$1,700 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-05,87% AV Level Silver Plan,,0.872813393,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$400 ,$800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$400 ,$0 ,$60 ,$400 ,$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200005,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep29,  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200005-06,94% AV Level Silver Plan,,0.937032732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800 ,$1600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$200 ,$0 ,$60 ,$200 ,$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200006,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200006-01,Standard Gold On Exchange Plan,,0.772469018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100 ",$8200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$500 ,$0 ,$60 ,"$1,350 ",$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200006,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200006-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200006,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep29, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200006-03,Limited Cost Sharing Plan Variation,,0.772469018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100 ",$8200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$500 ,$0 ,$60 ,"$1,350 ",$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-01,Standard Silver On Exchange Plan,,0.701719513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$600 ,$0 ,$90 ,"$2,500 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-03,Limited Cost Sharing Plan Variation,,0.701719513,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$600 ,$0 ,$90 ,"$2,500 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-04,73% AV Level Silver Plan,,0.73446465,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$600 ,$0 ,$70 ,"$1,700 ","$1,300 ",$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-05,87% AV Level Silver Plan,,0.872813393,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$400 ,$800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$400 ,$400 ,$0 ,$60 ,$400 ,$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200008,"MVP Premier Plus HDHP Silver 3, HSA, NS, INN, Dep25  Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF009,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200008-06,94% AV Level Silver Plan,,0.937032732,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$800 ,$1600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$200 ,$0 ,$60 ,$200 ,$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200009,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200009-01,Standard Gold On Exchange Plan,,0.772469018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100 ",$8200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$500 ,$0 ,$60 ,"$1,350 ",$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200009,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200009-02,Zero Cost Sharing Plan Variation,,1,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,14-1640868,56184NY0200009,"MVP Premier Plus HDHP Gold 2, HSA, NS, INN, Dep25, Acupuncture, Preferred Facilities, Preventive Rx, Telemedicine, Wellness",56184NY020,,NYN001,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.mvphealthcare.com/members/make-a-payment/,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0200009-03,Limited Cost Sharing Plan Variation,,0.772469018,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,100 ",$8200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$500 ,$0 ,$60 ,"$1,350 ",$500 ,$0 ,$60 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,14-1640868,56184NY0170077,"MVP HMO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170077-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,14-1640868,56184NY0170078,"MVP HMO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP",56184NY017,,NYN002,NYS001,NYF005,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170078-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,14-1640868,56184NY0170085,"MVP HMO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness,áUnlimited SNF, 3PCP, DP",56184NY017,,NYN002,NYS001,NYF007,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0170085-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0210032,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF,Wellness, DP, FPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210032-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0210035,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210035-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,14-1640868,56184NY0210036,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DP, FPá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210036-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0160103,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture,  Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160103-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,000 ",$60 ,"$1,900 ",$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0160104,"MVP HMO HDHP Bronze 9, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture,  Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY016,,NYN002,NYS001,NYF003,Existing,HMO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0160104-01,Standard Bronze On Exchange Plan,,0.621117433,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,000 ",$60 ,"$1,900 ",$0 ,$0 ,$0 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0210033,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210033-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0210034,"MVP HMO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DPáá",56184NY021,,NYN002,NYS001,NYF006,Existing,HMO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210034-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030013,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030013-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0210037,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DPá",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210037-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"MVP Health Plan, Inc.",56184,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,14-1640868,56184NY0210038,"MVP HMO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Rx, Telemedicine, Unlimited SNF, Wellness, DP",56184NY021,,NYN002,NYS001,NYF007,Existing,HMO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,56184NY0210038-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030001,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030001-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030002,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030002-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030003,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030003-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030004,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030004-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030005,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030005-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030006,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030006-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030007,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030007-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030008,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030008-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030033,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030033-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030034,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030034-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030035,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030035-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030036,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030036-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030037,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030037-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030038,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030038-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030039,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030039-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-3783732,61405NY0030040,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030040-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030009,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030009-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030010,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030010-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030011,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030011-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030012,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030012-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030014,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030014-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030015,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030015-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030016,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030016-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030041,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030041-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030042,"Healthfirst Bronze Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030042-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030043,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030043-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030044,"Healthfirst Silver Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030044-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030028,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030028-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030045,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030045-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030046,"Healthfirst Gold Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030046-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030047,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030047-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-3783732,61405NY0030048,"Healthfirst Platinum Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030048-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030017,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030017-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030018,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030018-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030019,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030019-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030020,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030020-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030021,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030021-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030022,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030022-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030023,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030023-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030024,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030024-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030049,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030049-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030050,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030050-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030051,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030051-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030052,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030052-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030053,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030053-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030054,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030054-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030055,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030055-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-3783732,61405NY0030056,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030056-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030025,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030025-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030026,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030026-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030027,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030027-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030029,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030029-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030030,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030030-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030031,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030031-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030032,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030032-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030072,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030072-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030077,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030077-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030078,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030078-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030079,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030079-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030057,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030057-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030058,"Healthfirst Bronze Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030058-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030059,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030059-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030060,"Healthfirst Silver Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030060-01,Standard Silver On Exchange Plan,71.96%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,950 ",$5900 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,950 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030061,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030061-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030062,"Healthfirst Gold Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030062-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030063,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030063-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-3783732,61405NY0030064,"Healthfirst Platinum Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030064-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,490 ","$1,344 ",$60 ,$0 ,"$3,670 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030065,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030065-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$240 ,"$2,016 ",$60 ,"$3,315 ","$3,420 ",$468 ,$44 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030066,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030066-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$240 ,"$2,016 ",$60 ,"$3,315 ","$3,420 ",$468 ,$44 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030067,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030067-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$240 ,"$2,016 ",$60 ,"$3,315 ","$3,420 ",$468 ,$44 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030068,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030068-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$240 ,"$2,016 ",$60 ,"$3,315 ","$3,420 ",$468 ,$44 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030073,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030073-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030074,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030074-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030075,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030075-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030076,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030076-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030081,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 25, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030081-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,040 ",$0 ,$60 ,$0 ,"$1,660 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030082,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 29, DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030082-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,040 ",$0 ,$60 ,$0 ,"$1,660 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030083,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030083-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,040 ",$0 ,$60 ,$0 ,"$1,660 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-3783732,61405NY0030084,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030084-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,040 ",$0 ,$60 ,$0 ,"$1,660 ",$259 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030069,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030069-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030070,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030070-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030071,"Healthfirst Bronze 6650 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030071-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030080,"Healthfirst Silver 40/75/4700 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030080-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030085,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 25, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030085-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030109,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030109-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030110,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030110-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030111,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030111-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030112,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030112-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010001,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010001-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0160001,"Oscar Simple Secure, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY016,,NYN001,NYS001,NYF005,Existing,EPO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0160001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0160001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$4,800 ",$0 ,$0 ,$80 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030086,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 29, DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030086-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030087,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 25, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030087-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-3783732,61405NY0030088,"Healthfirst Gold 25/50/0 Pro Plus EPO, NS, INN, Dependent Age 29, No DP, No FP, Family Dental, Family Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030088-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030089,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030089-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030090,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030090-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030091,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030091-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030092,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030092-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030097,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030097-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030098,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030098-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030099,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030099-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030100,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030100-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030105,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 25, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030105-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030106,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 29, DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030106-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030107,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 25, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030107-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,13-3783732,61405NY0030108,"Healthfirst Gold 25/50/0 Pro EPO, NS, INN, Dependent Age 29, No DP, FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF002,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030108-01,Standard Gold On Exchange Plan,78.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,710 ","$1,792 ",$60 ,$0 ,"$4,730 ",$346 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030093,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030093-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030094,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030094-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030095,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030095-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030096,"Healthfirst Bronze 6650 Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards, HSA Compatible",61405NY003,,NYN001,NYS001,NYF005,New,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030096-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$300 ,"$2,520 ",$60 ,"$4,144 ","$4,275 ",$585 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030101,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 25, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030101-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030102,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 29, DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030102-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030103,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 25, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030103-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,"Healthfirst Insurance Company, Inc.",61405,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-3783732,61405NY0030104,"Healthfirst Silver 40/75/4700 Pro EPO, NS, INN, Dependent Age 29, No DP, No FP, Pediatric Dental, Pediatric Vision, Acupuncture, Free Telemedicine, Fitness & Wellness Rewards",61405NY003,,NYN001,NYS001,NYF003,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://hfbillpay.org,,http://healthfirst.org/formulary/,61405NY0030104-01,Standard Silver On Exchange Plan,70.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,700 ",$9400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,700 ","$4,640 ","$2,240 ",$60 ,"$1,296 ","$3,720 ",$432 ,$55 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010001,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010001,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010001-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010002,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010002-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010002,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0010002,"Oscar Classic Platinum, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY001,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0110001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0010002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0010002-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030001,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030001-01,Standard Gold On Exchange Plan,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030001,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030001,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030001-03,Limited Cost Sharing Plan Variation,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030002,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030002-01,Standard Gold On Exchange Plan,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030002,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0030002,"Oscar Classic Gold, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY003,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0120001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0030002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0030002-03,Limited Cost Sharing Plan Variation,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-01,Standard Silver On Exchange Plan,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-03,Limited Cost Sharing Plan Variation,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-04,73% AV Level Silver Plan,73.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,400 ","$1,600 ",$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$400 ,$0 ,$200 ,$300 ,$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050001,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050001-06,94% AV Level Silver Plan,93.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$200 ,$0 ,$200 ,$0 ,$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-01,Standard Silver On Exchange Plan,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-03,Limited Cost Sharing Plan Variation,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-04,73% AV Level Silver Plan,73.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,400 ","$1,600 ",$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$400 ,$0 ,$200 ,$300 ,$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0050002,"Oscar Classic Silver, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY005,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0140001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0050002-06,94% AV Level Silver Plan,93.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$200 ,$0 ,$200 ,$0 ,$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080001,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080001,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080001,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080002,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080002-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080002,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0080002,"Oscar Classic Bronze, ST, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY008,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,74289NY0130001,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0080002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0080002-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0110001,"Oscar Classic Platinum, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY011,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0110001-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0110001,"Oscar Classic Platinum, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY011,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0110001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0110001,"Oscar Classic Platinum, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY011,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY0110001-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,"$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0120001,"Oscar Classic Gold, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY012,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0120001-01,Standard Gold On Exchange Plan,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0120001,"Oscar Classic Gold, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY012,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0120001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0120001,"Oscar Classic Gold, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY012,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY0120001-03,Limited Cost Sharing Plan Variation,79.77%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,100 ",$0 ,$200 ,$600 ,"$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0130001,"Oscar Classic Bronze, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY013,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0130001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0130001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0130001,"Oscar Classic Bronze, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY013,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0130001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0130001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0130001,"Oscar Classic Bronze, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY013,,NYN001,NYS001,NYF004,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0130001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY0130001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$10 ,"$1,100 ",$200 ,"$4,000 ",$200 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-01,Standard Silver On Exchange Plan,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-03,Limited Cost Sharing Plan Variation,71.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$1,600 ",$0 ,$200 ,"$1,700 ",$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-04,73% AV Level Silver Plan,73.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,25.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,400 ","$1,600 ",$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$300 ,$400 ,$0 ,$200 ,$300 ,$900 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,46-2043136,74289NY0140001,"Oscar Classic Silver, Child Only, ST, INN, Pediatric Dental, Step Tracking Rewards",74289NY014,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY0140001-06,94% AV Level Silver Plan,93.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,5.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$200 ,$0 ,$200 ,$0 ,$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1020001,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY102,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1020001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1020001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1020002,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY102,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1020002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1020002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1040001,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY104,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1040001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1040001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1040002,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY104,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1040002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1040002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1240001,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY124,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1240001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1240001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1240002,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY124,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1240002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1240002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1260001,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 25, FP",74289NY126,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1260001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1260001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1260002,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 29, FP",74289NY126,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1260002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1260002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1560001,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY156,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1560001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1560001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1560002,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY156,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1560002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1560002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1580001,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 25, FP",74289NY158,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1580001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1580001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1580002,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 29, FP",74289NY158,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1580002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1580002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1880001,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY188,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1880001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1880001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1880002,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY188,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1880002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1880002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1900001,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 25, FP",74289NY190,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1900001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1900001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY1900002,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 29, FP",74289NY190,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1900002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1900002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2040001,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY204,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2040001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2040001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2040002,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY204,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2040002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2040002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2060001,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 25, FP",74289NY206,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2060001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2060001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2060002,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 29, FP",74289NY206,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2060002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2060002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2360001,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY236,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2360001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2360001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2360002,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY236,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2360002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2360002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2380001,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 25, FP",74289NY238,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2380001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2380001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,46-2043136,74289NY2380002,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 29, FP",74289NY238,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2380002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2380002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1030001,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 25, DP",74289NY103,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1030001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1030001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1030002,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 29, DP",74289NY103,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1030002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1030002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1050001,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 25, DP",74289NY105,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1050001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1050002,"Oscar Circle Gold $5000, INN, Pediatric Dental, Dep 29, DP",74289NY105,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1050002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100001,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100001,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100001,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100001-03,Limited Cost Sharing Plan Variation,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100002,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100002,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1100002,"Oscar Saver Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY110,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1100002-03,Limited Cost Sharing Plan Variation,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-01,Standard Silver On Exchange Plan,70.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$0 ,"$1,100 ",$200 ,"$2,500 ",$0 ,$800 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-03,Limited Cost Sharing Plan Variation,70.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$0 ,"$1,100 ",$200 ,"$2,500 ",$0 ,$800 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-04,73% AV Level Silver Plan,73.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$0 ,$900 ,$200 ,"$2,000 ",$0 ,$600 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-05,87% AV Level Silver Plan,87.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$0 ,$600 ,$200 ,$600 ,$0 ,$500 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110001,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110001-06,94% AV Level Silver Plan,94.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850 ,$1700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$100 ,$200 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$0 ,$600 ,$200 ,$100 ,$0 ,$500 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-01,Standard Silver On Exchange Plan,70.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$0 ,"$1,100 ",$200 ,"$2,500 ",$0 ,$800 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-03,Limited Cost Sharing Plan Variation,70.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$0 ,"$1,100 ",$200 ,"$2,500 ",$0 ,$800 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-04,73% AV Level Silver Plan,73.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$0 ,$900 ,$200 ,"$2,000 ",$0 ,$600 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-05,87% AV Level Silver Plan,87.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,600 ",$5200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$0 ,$600 ,$200 ,$600 ,$0 ,$500 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1110002,"Oscar Saver Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY111,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1110002-06,94% AV Level Silver Plan,94.94%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$850 ,$1700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$100 ,$200 per group,10.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$0 ,$600 ,$200 ,$100 ,$0 ,$500 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120001,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120001-01,Standard Gold On Exchange Plan,77.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$0 ,"$1,000 ",$200 ,"$1,500 ",$0 ,$700 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120001,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120001,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120001-03,Limited Cost Sharing Plan Variation,77.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$0 ,"$1,000 ",$200 ,"$1,500 ",$0 ,$700 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120002,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120002-01,Standard Gold On Exchange Plan,77.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$0 ,"$1,000 ",$200 ,"$1,500 ",$0 ,$700 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120002,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,46-2043136,74289NY1120002,"Oscar Saver Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY112,,NYN001,NYS001,NYF006,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1120002-03,Limited Cost Sharing Plan Variation,77.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$0 ,"$1,000 ",$200 ,"$1,500 ",$0 ,$700 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1250001,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 25, DP",74289NY125,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1250001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1250001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1250002,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 29, DP",74289NY125,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1250002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1250002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1270001,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 25",74289NY127,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1270001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1270001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1270002,"Oscar Circle Gold $2000, INN, Pediatric Dental, Dep 29",74289NY127,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1270002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY1270002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1570001,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 25, DP",74289NY157,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1570001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1570001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1570002,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 29, DP",74289NY157,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1570002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1570002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1590001,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 25",74289NY159,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1590001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1590001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1590002,"Oscar Circle Platinum $0, INN, Pediatric Dental, Dep 29",74289NY159,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1590002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY1590002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1890001,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 25, DP",74289NY189,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1890001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1890001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1890002,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 29, DP",74289NY189,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1890002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1890002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1910001,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 25",74289NY191,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1910001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1910001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY1910002,"Oscar Circle Plus Gold $5000, INN, Pediatric Dental, Dep 29",74289NY191,,NYN002,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1910002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF002,74289NY1910002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2050001,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 25, DP",74289NY205,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2050001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2050001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2050002,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 29, DP",74289NY205,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2050002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2050002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2070001,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 25",74289NY207,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2070001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2070001-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY0780002,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY078,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0780002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0780002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1170002,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 29, DP",74289NY117,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1170002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1170002-01,Standard Gold On Exchange Plan,78.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1190001,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 25",74289NY119,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1190001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1190001-01,Standard Gold On Exchange Plan,78.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1190002,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 29",74289NY119,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1190002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1190002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1290001,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 25, DP",74289NY129,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1290001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1290001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2070002,"Oscar Circle Plus Gold $2000, INN, Pediatric Dental, Dep 29",74289NY207,,NYN002,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2070002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF003,74289NY2070002-01,Standard Gold On Exchange Plan,78.11%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$150 ,$300 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$200 ,$700 ,$200 ,"$1,400 ","$1,100 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2370001,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 25, DP",74289NY237,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2370001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2370001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2370002,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 29, DP",74289NY237,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2370002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2370002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2390001,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 25",74289NY239,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2390001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2390001-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,46-2043136,74289NY2390002,"Oscar Circle Plus Platinum $0, INN, Pediatric Dental, Dep 29",74289NY239,,NYN002,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2390002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF001,74289NY2390002-01,Standard Platinum On Exchange Plan,88.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$700 ,$0 ,$200 ,$0 ,$700 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520001,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520001,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520001,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520001-03,Limited Cost Sharing Plan Variation,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520002,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520002,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0520002,"Oscar Simple Bronze, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY052,,NYN001,NYS001,NYF011,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0520002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY0520002-03,Limited Cost Sharing Plan Variation,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-01,Standard Silver On Exchange Plan,70.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-03,Limited Cost Sharing Plan Variation,70.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-04,73% AV Level Silver Plan,73.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-05,87% AV Level Silver Plan,87.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850 ",$3700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,850 ",$3700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,800 ",$50 ,$0 ,$200 ,"$1,400 ",$300 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640001,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640001-06,94% AV Level Silver Plan,94.96%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$50 ,$0 ,$200 ,$500 ,$80 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-01,Standard Silver On Exchange Plan,70.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-03,Limited Cost Sharing Plan Variation,70.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-04,73% AV Level Silver Plan,73.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-05,87% AV Level Silver Plan,87.97%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,850 ",$3700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,850 ",$3700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,800 ",$50 ,$0 ,$200 ,"$1,400 ",$300 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0640002,"Oscar Simple Silver, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY064,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY0640002-06,94% AV Level Silver Plan,94.96%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$550 ,$1100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$50 ,$0 ,$200 ,$500 ,$80 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650001,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650001-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650001,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650001,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep25, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650001-03,Limited Cost Sharing Plan Variation,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650002,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650002-01,Standard Gold On Exchange Plan,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650002,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,46-2043136,74289NY0650002,"Oscar Simple Gold, NS, INN, Pediatric Dental, Dep29, Step Tracking Rewards",74289NY065,,NYN001,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0650002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY0650002-03,Limited Cost Sharing Plan Variation,76.81%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,900 ",$100 ,$0 ,$200 ,"$1,400 ","$1,000 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY0780001,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY078,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0780001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0780001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY0800001,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 25, FP",74289NY080,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0800001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0800001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY0800002,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 29, FP",74289NY080,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0800002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0800002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1160001,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY116,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1160001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1160001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1160002,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY116,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1160002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1160002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1180001,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 25, FP",74289NY118,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1180001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1180001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1180002,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 29, FP",74289NY118,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1180002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1180002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1280001,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 25, DP, FP",74289NY128,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1280001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1280001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1280002,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 29, DP, FP",74289NY128,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1280002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1280002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1300001,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 25, FP",74289NY130,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1300001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1300001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1300002,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 29, FP",74289NY130,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1300002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1300002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1640001,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY164,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1640001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1640001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1640002,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY164,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1640002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1640002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1660001,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 25, FP",74289NY166,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1660001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1660001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1660002,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 29, FP",74289NY166,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1660002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1660002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1960001,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY196,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1960001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1960001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1960002,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY196,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1960002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1960002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1980001,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 25, FP",74289NY198,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1980001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1980001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY1980002,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 29, FP",74289NY198,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1980002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1980002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY2080001,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 25, DP, FP",74289NY208,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2080001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2080001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY2080002,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 29, DP, FP",74289NY208,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2080002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2080002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY2100001,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 25, FP",74289NY210,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2100001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2100001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,46-2043136,74289NY2100002,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 29, FP",74289NY210,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2100002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2100002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY0790001,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 25, DP",74289NY079,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0790001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0790001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY0790002,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 29, DP",74289NY079,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0790002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0790002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY0810001,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 25",74289NY081,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0810001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0810001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY0810002,"Oscar Circle Gold $0, INN, Pediatric Dental, Dep 29",74289NY081,,NYN001,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0810002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY0810002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1170001,"Oscar Circle Gold $1500, INN, Pediatric Dental, Dep 25, DP",74289NY117,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1170001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1170001-01,Standard Gold On Exchange Plan,78.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1290002,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 29, DP",74289NY129,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1290002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1290002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1310001,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 25",74289NY131,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1310001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1310001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1310002,"Oscar Circle Gold $750, INN, Pediatric Dental, Dep 29",74289NY131,,NYN001,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1310002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1310002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1650001,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 25, DP",74289NY165,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1650001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1650001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1650002,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 29, DP",74289NY165,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1650002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1650002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1340001,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY134,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1340001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1340001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1340002,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29, FP",74289NY134,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1340002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1340002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1680001,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY168,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1680001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1680001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1670001,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 25",74289NY167,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1670001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1670001-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1670002,"Oscar Circle Plus Gold $0, INN, Pediatric Dental, Dep 29",74289NY167,,NYN002,NYS001,NYF005,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1670002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF005,74289NY1670002-01,Standard Gold On Exchange Plan,78.95%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$1,000 ",$0 ,$200 ,$0 ,$800 ,$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1970001,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 25, DP",74289NY197,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1970001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1970001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1970002,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 29, DP",74289NY197,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1970002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1970002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1990001,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 25",74289NY199,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1990001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1990001-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY1990002,"Oscar Circle Plus Gold $1500, INN, Pediatric Dental, Dep 29",74289NY199,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1990002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY1990002-01,Standard Gold On Exchange Plan,79.55%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,500 ",$200 ,$800 ,$200 ,"$1,400 ","$1,200 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY2090001,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 25, DP",74289NY209,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2090001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2090001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY2090002,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 29, DP",74289NY209,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2090002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2090002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY2110001,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 25",74289NY211,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2110001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2110001-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,46-2043136,74289NY2110002,"Oscar Circle Plus Gold $750, INN, Pediatric Dental, Dep 29",74289NY211,,NYN002,NYS001,NYF004,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2110002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF004,74289NY2110002-01,Standard Gold On Exchange Plan,79.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$200 ,"$1,000 ",$200 ,$800 ,"$1,200 ",$100 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0820001,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY082,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0820001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0820001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0820002,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY082,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0820002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0820002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0840001,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 25, FP",74289NY084,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0840001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0840001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0840002,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 29, FP",74289NY084,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0840002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0840002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0980001,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 25, DP, FP",74289NY098,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0980001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY0980001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY0980002,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 29, DP, FP",74289NY098,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0980002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY0980002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1000001,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 25, FP",74289NY100,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1000001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1000001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1000002,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 29, FP",74289NY100,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1000002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1000002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1320001,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY132,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1320001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1320001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1320002,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY132,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1320002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1320002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1680002,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY168,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1680002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1680002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1700001,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 25, FP",74289NY170,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1700001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1700001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1700002,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 29, FP",74289NY170,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1700002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1700002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1840001,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 25, DP, FP",74289NY184,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1840001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1840001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1840002,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 29, DP, FP",74289NY184,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1840002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1840002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1860001,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 25, FP",74289NY186,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1860001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1860001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1710002,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 29",74289NY171,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1710002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1710002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1850001,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 25, DP",74289NY185,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1850001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1850001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY1860002,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 29, FP",74289NY186,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1860002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1860002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY2120001,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 25, DP, FP",74289NY212,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2120001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2120001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY2120002,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 29, DP, FP",74289NY212,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2120002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2120002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY2140001,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 25, FP",74289NY214,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2140001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2140001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,46-2043136,74289NY2140002,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 29, FP",74289NY214,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2140002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2140002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0830001,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 25, DP",74289NY083,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0830001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0830001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0830002,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 29, DP",74289NY083,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0830002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0830002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0850001,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 25",74289NY085,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0850001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0850001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0850002,"Oscar Circle Silver $3500, INN, Pediatric Dental, Dep 29",74289NY085,,NYN001,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0850002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY0850002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0990001,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 25, DP",74289NY099,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0990001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY0990001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY0990002,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 29, DP",74289NY099,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0990002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY0990002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1010001,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 25",74289NY101,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1010001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1010001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1010002,"Oscar Circle Silver $7900, INN, Pediatric Dental, Dep 29",74289NY101,,NYN001,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1010002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1010002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1330001,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 25, DP",74289NY133,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1330001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1330001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1330002,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29, DP",74289NY133,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1330002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1330002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1350001,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29, DP",74289NY135,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1350001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1350001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1350002,"Oscar Circle Silver $4500, INN, Pediatric Dental, Dep 29",74289NY135,,NYN001,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1350002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY1350002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1690001,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 25, DP",74289NY169,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1690001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1690001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1690002,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 29, DP",74289NY169,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1690002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1690002-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1710001,"Oscar Circle Plus Silver $3500, INN, Pediatric Dental, Dep 25",74289NY171,,NYN002,NYS001,NYF008,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1710001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF008,74289NY1710001-01,Standard Silver On Exchange Plan,71.38%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,500 ",$7000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,500 ",$300 ,$600 ,$200 ,"$1,400 ","$1,400 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1850002,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 29, DP",74289NY185,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1850002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1850002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1870001,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 25",74289NY187,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1870001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1870001-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY1870002,"Oscar Circle Plus Silver $7900, INN, Pediatric Dental, Dep 29",74289NY187,,NYN002,NYS001,NYF006,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1870002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF006,74289NY1870002-01,Standard Silver On Exchange Plan,69.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,600 ",$200 ,$0 ,$200 ,"$1,400 ","$1,600 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY2130001,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 25, DP",74289NY213,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2130001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2130001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2400002,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY240,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2400002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2400002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2420001,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 25, FP",74289NY242,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2420001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2420001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2420002,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 29, FP",74289NY242,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2420002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2420002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2440001,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY244,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2440001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2440001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY2130002,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 29, DP",74289NY213,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2130002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2130002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY2150001,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 25",74289NY215,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2150001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2150001-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,46-2043136,74289NY2150002,"Oscar Circle Plus Silver $4500, INN, Pediatric Dental, Dep 29",74289NY215,,NYN002,NYS001,NYF007,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2150002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF007,74289NY2150002-01,Standard Silver On Exchange Plan,69.12%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,500 ",$300 ,$600 ,$200 ,"$3,000 ",$600 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1400001,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 25, DP, FP",74289NY140,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1400001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1400001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1400002,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 29, DP, FP",74289NY140,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1400002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1400002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1420001,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 25, FP",74289NY142,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1420001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1420001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1420002,"Oscar Circle Silver $3000 HAS, INN, Pediatric Dental, Dep 29, FP",74289NY142,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1420002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1420002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1520001,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 25, DP, FP",74289NY152,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1520001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1520001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1520002,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 29, DP, FP",74289NY152,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1520002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1520002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1540001,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 25, FP",74289NY154,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1540001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1540001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY1540002,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 29, FP",74289NY154,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1540002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1540002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2200001,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 25, DP, FP",74289NY220,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2200001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2200001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2200002,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 29, DP, FP",74289NY220,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2200002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2200002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2220001,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 25, FP",74289NY222,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2220001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2220001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2220002,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 29, FP",74289NY222,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2220002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2220002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2320001,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 25, DP, FP",74289NY232,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2320001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2320001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2320002,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 29, DP, FP",74289NY232,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2320002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2320002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2340001,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 25, FP",74289NY234,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2340001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2340001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2340002,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 29, FP",74289NY234,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2340002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2340002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2400001,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 25, DP, FP",74289NY240,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2400001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2400001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2440002,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 29, DP, FP",74289NY244,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2440002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2440002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2460001,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 25, FP",74289NY246,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2460001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2460001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2430002,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 29",74289NY243,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2430002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2430002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2450001,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 25, DP",74289NY245,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2450001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2450001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2450002,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 29, DP",74289NY245,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2450002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2450002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2470001,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 25",74289NY247,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2470001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2470001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2470002,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 29",74289NY247,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2470002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2470002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0860001,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY086,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0860001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0860001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,46-2043136,74289NY2460002,"Oscar Circle Plus Silver $0, INN, Pediatric Dental, Dep 29, FP",74289NY246,,NYN002,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2460002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2460002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1410001,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 25, DP",74289NY141,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1410001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1410001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1410002,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 29, DP",74289NY141,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1410002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1410002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1430001,"Oscar Circle Silver $3000 HSA, INN, Pediatric Dental, Dep 25",74289NY143,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1430001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1430001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1430002,"Oscar Circle Silver $3000 HAS, INN, Pediatric Dental, Dep 29",74289NY143,,NYN001,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1430002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY1430002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1530001,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 25, DP",74289NY153,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1530001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1530001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1530002,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 29, DP",74289NY153,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1530002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1530002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1550001,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 25",74289NY155,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1550001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1550001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY1550002,"Oscar Circle Silver $2700, INN, Pediatric Dental, Dep 29",74289NY155,,NYN001,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1550002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY1550002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2210001,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 25, DP",74289NY221,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2210001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2210001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2210002,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 29, DP",74289NY221,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2210002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2210002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2230001,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 25",74289NY223,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2230001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2230001-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2230002,"Oscar Circle Plus Silver $3000 HSA, INN, Pediatric Dental, Dep 29",74289NY223,,NYN002,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2230002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF009,74289NY2230002-01,Standard Silver On Exchange Plan,70.57%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$0 ,$700 ,$200 ,"$3,000 ",$0 ,$400 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2330001,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 25, DP",74289NY233,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2330001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2330001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2330002,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 29, DP",74289NY233,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2330002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2330002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2350001,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 25",74289NY235,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2350001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2350001-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2350002,"Oscar Circle Plus Silver $2700, INN, Pediatric Dental, Dep 29",74289NY235,,NYN002,NYS001,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2350002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF010,74289NY2350002-01,Standard Silver On Exchange Plan,71.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$300 ,$900 ,$200 ,"$1,400 ","$1,500 ",$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2410001,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 25, DP",74289NY241,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2410001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2410001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2410002,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 29, DP",74289NY241,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2410002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2410002-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,46-2043136,74289NY2430001,"Oscar Circle Silver $0, INN, Pediatric Dental, Dep 25",74289NY243,,NYN001,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2430001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF011,74289NY2430001-01,Standard Silver On Exchange Plan,70.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,800 ",$0 ,$200 ,$0 ,"$1,500 ",$300 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0860002,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY086,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0860002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0860002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0880001,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 25, FP",74289NY088,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0880001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0880001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0880002,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 29, FP",74289NY088,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0880002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0880002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0900001,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 25, DP, FP",74289NY090,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0900001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0900001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0900002,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 29, DP, FP",74289NY090,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0900002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0900002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0920001,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 25, FP",74289NY092,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0920001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0920001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY0920002,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 29, FP",74289NY092,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0920002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0920002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1440001,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, DP, FP",74289NY144,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1440001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1440001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1440002,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, DP, FP",74289NY144,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1440002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1440002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1460001,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, FP",74289NY146,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1460001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1460001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1460002,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, FP",74289NY146,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1460002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1460002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1720001,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 25, DP, FP",74289NY172,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1720001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1720001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1720002,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 29, DP, FP",74289NY172,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1720002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1720002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1740001,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 25, FP",74289NY174,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1740001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1740001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1740002,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 29, FP",74289NY174,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1740002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1740002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1760001,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 25, DP, FP",74289NY176,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1760001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1760001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1760002,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 29, DP, FP",74289NY176,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1760002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1760002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1780001,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 25, FP",74289NY178,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1780001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1780001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY1780002,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 29, FP",74289NY178,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1780002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1780002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY2240001,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, DP, FP",74289NY224,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2240001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2240001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY2240002,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, DP, FP",74289NY224,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2240002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2240002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY2260001,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, FP",74289NY226,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2260001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2260001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,46-2043136,74289NY2260002,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, FP",74289NY226,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2260002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2260002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0870001,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 25, DP",74289NY087,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0870001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0870001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0870002,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 29, DP",74289NY087,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0870002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0870002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0890001,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 25",74289NY089,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0890001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0890001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0890002,"Oscar Circle Bronze $4000, INN, Pediatric Dental, Dep 29",74289NY089,,NYN001,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0890002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY0890002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0910001,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 25, DP",74289NY091,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0910001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0910001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0910002,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 29, DP",74289NY091,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0910002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0910002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0930001,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 25",74289NY093,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0930001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0930001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY0930002,"Oscar Circle Bronze $7900, INN, Pediatric Dental, Dep 29",74289NY093,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY0930002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY0930002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1450001,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, DP",74289NY145,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1450001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1450001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1450002,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, DP",74289NY145,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1450002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1450002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1470001,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 25",74289NY147,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1470001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1470001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1470002,"Oscar Circle Bronze $6650 HSA, INN, Pediatric Dental, Dep 29",74289NY147,,NYN001,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1470002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1470002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1730001,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 25, DP",74289NY173,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1730001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1730001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1730002,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 29, DP",74289NY173,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1730002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1730002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1750001,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 25",74289NY175,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1750001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1750001-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-04,73% AV Level Silver Plan,73.91%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,"$5,750 ",$11500 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-05,87% AV Level Silver Plan,87.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,250 ",$380 ,$0 ,$60 ,"$1,250 ",$840 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980169,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980169-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980171,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980171-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980177,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980177-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980179,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980179-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1750002,"Oscar Circle Plus Bronze $4000, INN, Pediatric Dental, Dep 29",74289NY175,,NYN002,NYS001,NYF013,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1750002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF013,74289NY1750002-01,Standard Bronze On Exchange Plan,61.37%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$20 ,"$1,100 ",$200 ,"$4,000 ",$300 ,$200 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1770001,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 25, DP",74289NY177,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1770001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1770001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1770002,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 29, DP",74289NY177,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1770002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1770002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1790001,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 25",74289NY179,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1790001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1790001-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY1790002,"Oscar Circle Plus Bronze $7900, INN, Pediatric Dental, Dep 29",74289NY179,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY1790002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY1790002-01,Standard Bronze On Exchange Plan,58.53%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY2250001,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 25, DP",74289NY225,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2250001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2250001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY2250002,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 29, DP",74289NY225,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2250002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2250002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY2270001,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 25",74289NY227,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2270001,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2270001-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,Oscar Insurance Corporation,74289,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,46-2043136,74289NY2270002,"Oscar Circle Plus Bronze $6650 HSA, INN, Pediatric Dental, Dep 29",74289NY227,,NYN002,NYS001,NYF012,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,No,,No,,No,,https://www.hioscar.com/hx/payment?state=NY&year=2019&hios=74289NY2270002,,https://www.hioscar.com/search/NY/drugs?year=2019&formulary=NYF012,74289NY2270002-01,Standard Bronze On Exchange Plan,61.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,300 ",$0 ,$0 ,$200 ,"$5,100 ",$0 ,$0 ,$80 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-01,Standard Silver On Exchange Plan,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-03,Limited Cost Sharing Plan Variation,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-04,73% AV Level Silver Plan,73.91%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,"$5,750 ",$11500 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-05,87% AV Level Silver Plan,87.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,250 ",$380 ,$0 ,$60 ,"$1,250 ",$840 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920006,Bassett Preferred Silver NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920006-06,94% AV Level Silver Plan,94.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$150 ,$0 ,$60 ,$0 ,"$1,550 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-01,Standard Silver On Exchange Plan,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-03,Limited Cost Sharing Plan Variation,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0920008,Bassett Preferred Silver NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF013,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920008-06,94% AV Level Silver Plan,94.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$150 ,$0 ,$60 ,$0 ,"$1,550 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-01,Standard Silver On Exchange Plan,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$20 ,"$2,070 ",$60 ,"$2,250 ",$140 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-03,Limited Cost Sharing Plan Variation,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$10 ,"$2,070 ",$60 ,"$2,250 ",$70 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$0 ,"$1,400 ",$60 ,$250 ,$80 ,"$1,320 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950008,Silver Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950008-06,94% AV Level Silver Plan,94.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,"$2,130 ",$60 ,$0 ,$0 ,$470 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-01,Standard Silver On Exchange Plan,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$20 ,"$2,070 ",$60 ,"$2,250 ",$140 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-03,Limited Cost Sharing Plan Variation,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$10 ,"$2,070 ",$60 ,"$2,250 ",$70 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$0 ,"$1,400 ",$60 ,$250 ,$80 ,"$1,320 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950010,Silver Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF012,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950010-06,94% AV Level Silver Plan,94.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,"$2,130 ",$60 ,$0 ,$0 ,$470 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950012,Bronze Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950012-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950012,Bronze Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950012,Bronze Select NS INN Dep29,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950012-03,Limited Cost Sharing Plan Variation,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950014,Bronze Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950014-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950014,Bronze Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,15-0329043,78124NY0950014,Bronze Select NS INN Dep25,78124NY095,,NYN011,NYS003,NYF016,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950014-03,Limited Cost Sharing Plan Variation,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980017,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980017-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980019,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980019-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980025,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980025-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980027,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980027-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980049,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980049-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980051,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980051-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980057,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980057-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980059,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980059-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980065,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980065-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980067,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980067-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980073,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980073-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980075,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980075-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980129,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980129-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980131,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980131-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980137,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980137-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980139,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980139-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980161,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980161-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980163,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980163-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980185,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980185-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0980187,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980187-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990065,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990065-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990067,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990067-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990073,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990073-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990075,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990075-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990081,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990081-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990083,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990083-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990089,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990089-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990091,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990091-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990265,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990265-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040269,Univera Access Bronze 1 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040269-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040271,Univera Access Bronze 1 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040271-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040277,Univera Access Bronze 2 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040277-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040279,Univera Access Bronze 2 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040279-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040285,Univera Access Bronze 2 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040285-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990097,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990097-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990099,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990099-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990105,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990105-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990107,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990107-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990225,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990225-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990227,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990227-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990233,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990233-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990235,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990235-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990241,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990241-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990243,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990243-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990249,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990249-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990251,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990251-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990257,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990257-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990259,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990259-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990267,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990267-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY0990289,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990289-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020161,Univera Access Platinum 1 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020161-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020163,Univera Access Platinum 1 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020163-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020169,Univera Access Platinum 1 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020169-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020171,Univera Access Platinum 1 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020171-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020177,Univera Access Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020177-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020179,Univera Access Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020179-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020185,Univera Access Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020185-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020187,Univera Access Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020187-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020209,Univera Access Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020209-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020211,Univera Access Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020211-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020217,Univera Access Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020217-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020219,Univera Access Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020219-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020225,Univera Access Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020225-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020227,Univera Access Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020227-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020233,Univera Access Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020233-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1020235,Univera Access Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020235-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030289,Univera Access Gold 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030289-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030291,Univera Access Gold 2 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030291-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030297,Univera Access Gold 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030297-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030299,Univera Access Gold 2 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030299-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030321,Univera Access Silver 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030321-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030323,Univera Access Silver 2 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030323-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030329,Univera Access Silver 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030329-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1030331,Univera Access Silver 2 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030331-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040257,Univera Access Bronze 1 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040257-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040259,Univera Access Bronze 1 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040259-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040265,Univera Access Bronze 1 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040265-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040267,Univera Access Bronze 1 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040267-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040273,Univera Access Bronze 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040273-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040275,Univera Access Bronze 2 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040275-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040281,Univera Access Bronze 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040281-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040283,Univera Access Bronze 2 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040283-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040401,Univera Access Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040401-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040403,Univera Access Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040403-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040409,Univera Access Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040409-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,15-0329043,78124NY1040411,Univera Access Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040411-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920002,Bassett Preferred Gold NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920002-01,Standard Gold On Exchange Plan,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920002,Bassett Preferred Gold NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920002,Bassett Preferred Gold NS INN Dep29 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920002-03,Limited Cost Sharing Plan Variation,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920004,Bassett Preferred Gold NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920004-01,Standard Gold On Exchange Plan,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920004,Bassett Preferred Gold NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0920004,Bassett Preferred Gold NS INN Dep25 Tiered Network,78124NY092,,NYN006,NYS005,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0920004-03,Limited Cost Sharing Plan Variation,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930008,Platinum Select NS INN Dep29,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930008-01,Standard Platinum On Exchange Plan,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$880 ,$0 ,$60 ,$0 ,$980 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930008,Platinum Select NS INN Dep29,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930008,Platinum Select NS INN Dep29,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930008-03,Limited Cost Sharing Plan Variation,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930010,Platinum Select NS INN Dep25,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930010-01,Standard Platinum On Exchange Plan,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$880 ,$0 ,$60 ,$0 ,$980 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930010,Platinum Select NS INN Dep25,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0930010,Platinum Select NS INN Dep25,78124NY093,,NYN011,NYS003,NYF006,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930010-03,Limited Cost Sharing Plan Variation,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940014,Gold Select NS INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940014-01,Standard Gold On Exchange Plan,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$930 ,$0 ,$60 ,$750 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940014,Gold Select NS INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940014,Gold Select NS INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940014-03,Limited Cost Sharing Plan Variation,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940016,Gold Select NS INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940016-01,Standard Gold On Exchange Plan,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$930 ,$0 ,$60 ,$750 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940016,Gold Select NS INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,15-0329043,78124NY0940016,Gold Select NS INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940016-03,Limited Cost Sharing Plan Variation,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990291,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990291-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990297,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990297-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990299,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990299-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990305,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990305-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990307,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990307-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990311,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990311-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990313,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990313-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990315,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990315-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990317,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990317-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY0990319,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990319-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020165,Univera Access Platinum 1 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020165-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020167,Univera Access Platinum 1 NS OON Pediatric Dental Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020167-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020173,Univera Access Platinum 1 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020173-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020175,Univera Access Platinum 1 NS OON Pediatric Dental Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020175-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020181,Univera Access Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020181-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020183,Univera Access Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020183-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020189,Univera Access Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020189-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020191,Univera Access Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020191-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020213,Univera Access Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020213-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020215,Univera Access Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020215-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020221,Univera Access Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020221-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020223,Univera Access Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020223-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020229,Univera Access Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020229-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020231,Univera Access Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020231-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020237,Univera Access Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020237-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1020239,Univera Access Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020239-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030293,Univera Access Gold 2 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030293-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030295,Univera Access Gold 2 NS OON Pediatric Dental Dep29 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030295-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030301,Univera Access Gold 2 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030301-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030303,Univera Access Gold 2 NS OON Pediatric Dental Dep25 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030303-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030325,Univera Access Silver 2 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030325-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030327,Univera Access Silver 2 NS OON Pediatric Dental Dep29 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030327-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030333,Univera Access Silver 2 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030333-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1030335,Univera Access Silver 2 NS OON Pediatric Dental Dep25 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030335-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040261,Univera Access Bronze 1 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040261-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040263,Univera Access Bronze 1 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040263-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040287,Univera Access Bronze 2 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040287-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040405,Univera Access Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040405-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040407,Univera Access Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040407-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980055,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980055-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980061,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980061-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980063,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980063-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980069,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980069-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990231,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990231-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040413,Univera Access Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040413-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,15-0329043,78124NY1040415,Univera Access Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040415-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900012,Bronze Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900012-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900012,Bronze Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900012-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900012,Bronze Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900012-03,Limited Cost Sharing Plan Variation,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900014,Bronze Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900014-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900014,Bronze Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900014-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0900014,Bronze Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF015,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900014-03,Limited Cost Sharing Plan Variation,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940018-01,Standard Gold On Exchange Plan,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940018-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940018-03,Limited Cost Sharing Plan Variation,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940020-01,Standard Gold On Exchange Plan,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940020-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940020-03,Limited Cost Sharing Plan Variation,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-01,Standard Silver On Exchange Plan,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-03,Limited Cost Sharing Plan Variation,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-04,73% AV Level Silver Plan,73.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-05,87% AV Level Silver Plan,87.57%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$400 ,$800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940024-06,94% AV Level Silver Plan,93.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-01,Standard Silver On Exchange Plan,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-03,Limited Cost Sharing Plan Variation,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-04,73% AV Level Silver Plan,73.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-05,87% AV Level Silver Plan,87.57%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$400 ,$800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,15-0329043,78124NY0940026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY094,,NYN011,NYS003,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0940026-06,94% AV Level Silver Plan,93.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980021,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980021-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980023,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980023-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980029,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980029-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980031,SimplyBlue Plus Platinum 2 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980031-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980053,SimplyBlue Plus Gold 1 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980053-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980071,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980071-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980077,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980077-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980079,SimplyBlue Plus Platinum 3 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980079-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980133,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980133-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980135,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980135-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980141,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980141-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980143,SimplyBlue Plus Gold 5 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980143-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980165,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980165-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980167,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980167-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980173,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980173-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980175,SimplyBlue Plus Platinum 5 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980175-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980181,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980181-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980183,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980183-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980189,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980189-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0980191,SimplyBlue Plus Platinum 6 NS OON Pediatric Dental Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980191-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990069,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990069-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990071,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990071-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990077,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990077-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990079,SimplyBlue Plus Gold 13 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990079-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990085,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990085-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990087,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990087-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990093,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990093-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990095,SimplyBlue Plus Gold 14 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990095-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990101,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990101-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990103,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990103-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990109,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990109-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990111,SimplyBlue Plus Silver 6 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990111-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990229,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990229-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990237,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990237-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990239,SimplyBlue Plus Platinum 4 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990239-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990245,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990245-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990247,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990247-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990253,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990253-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990255,SimplyBlue Plus Gold 17 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990255-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990261,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990261-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990263,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990263-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990269,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990269-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990271,SimplyBlue Plus Gold 18 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990271-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-06,94% AV Level Silver Plan,94.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,"$2,130 ",$60 ,$0 ,$0 ,$470 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930002,Platinum Standard ST INN Dep29,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930002-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930002,Platinum Standard ST INN Dep29,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930002,Platinum Standard ST INN Dep29,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930002-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930004,Platinum Standard ST INN Dep25,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930004-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930004,Platinum Standard ST INN Dep25,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930004,Platinum Standard ST INN Dep25,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0930006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930004-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930006,Platinum Standard Child Only ST INN,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930006-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930006,Platinum Standard Child Only ST INN,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY0990293,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990293-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020162,Univera Access Platinum 1 NS OON Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020162-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020164,Univera Access Platinum 1 NS OON Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020164-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020170,Univera Access Platinum 1 NS OON Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020170-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020172,Univera Access Platinum 1 NS OON Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020172-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020178,Univera Access Platinum 2 NS OON Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020178-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020180,Univera Access Platinum 2 NS OON Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020180-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020186,Univera Access Platinum 2 NS OON Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020186-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020188,Univera Access Platinum 2 NS OON Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020188-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020210,Univera Access Platinum 3 NS OON Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020210-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020212,Univera Access Platinum 3 NS OON Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020212-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020218,Univera Access Platinum 3 NS OON Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020218-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020220,Univera Access Platinum 3 NS OON Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020220-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020226,Univera Access Platinum 4 NS OON Dep29 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020226-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020228,Univera Access Platinum 4 NS OON Dep29 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020228-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020234,Univera Access Platinum 4 NS OON Dep25 Adult Vision DP FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020234-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1020236,Univera Access Platinum 4 NS OON Dep25 Adult Vision FP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020236-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030290,Univera Access Gold 2 NS OON Dep29 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030290-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030292,Univera Access Gold 2 NS OON Dep29 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030292-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030298,Univera Access Gold 2 NS OON Dep25 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030298-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030300,Univera Access Gold 2 NS OON Dep25 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030300-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030322,Univera Access Silver 2 NS OON Dep29 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030322-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030324,Univera Access Silver 2 NS OON Dep29 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030324-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030330,Univera Access Silver 2 NS OON Dep25 Adult Vision DP FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030330-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1030332,Univera Access Silver 2 NS OON Dep25 Adult Vision FP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030332-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040258,Univera Access Bronze 1 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040258-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040260,Univera Access Bronze 1 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040260-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040266,Univera Access Bronze 1 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040266-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040268,Univera Access Bronze 1 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040268-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040274,Univera Access Bronze 2 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040274-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040276,Univera Access Bronze 2 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040276-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040282,Univera Access Bronze 2 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040282-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040284,Univera Access Bronze 2 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040284-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040402,Univera Access Bronze 4 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040402-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040404,Univera Access Bronze 4 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040404-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040410,Univera Access Bronze 4 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040410-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,15-0329043,78124NY1040412,Univera Access Bronze 4 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040412-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-01,Standard Silver On Exchange Plan,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$20 ,"$2,070 ",$60 ,"$2,250 ",$140 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-03,Limited Cost Sharing Plan Variation,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$10 ,"$2,070 ",$60 ,"$2,250 ",$70 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$0 ,"$1,400 ",$60 ,$250 ,$80 ,"$1,320 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900008,Silver Select NS INN Dep29,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900008-06,94% AV Level Silver Plan,94.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,"$2,130 ",$60 ,$0 ,$0 ,$470 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-01,Standard Silver On Exchange Plan,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$20 ,"$2,070 ",$60 ,"$2,250 ",$140 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-03,Limited Cost Sharing Plan Variation,71.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,250 ",$10 ,"$2,070 ",$60 ,"$2,250 ",$70 ,$940 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0900010,Silver Select NS INN Dep25,78124NY090,,NYN005,NYS001,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900010-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$0 ,"$1,400 ",$60 ,$250 ,$80 ,"$1,320 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0930006,Platinum Standard Child Only ST INN,78124NY093,,NYN011,NYS003,NYF004,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0930006-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940002,Gold Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940002-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940002,Gold Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940002,Gold Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940002-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940004,Gold Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940004-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940004,Gold Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940004,Gold Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940004-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940006,Gold Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940006-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940006,Gold Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940006,Gold Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940006-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940008,Silver Standard ST INN Dep29,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940008-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940010,Silver Standard ST INN Dep25,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0940012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940010-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0940012,Silver Standard Child Only ST INN,78124NY094,,NYN011,NYS003,NYF010,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0940012-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950002,Bronze Standard HSA ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950002-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950002,Bronze Standard HSA ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950002,Bronze Standard HSA ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950002-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950004,Bronze Standard HSA ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950004-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950004,Bronze Standard HSA ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950004,Bronze Standard HSA ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950004-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950006,Bronze Standard HSA Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950006-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950006,Bronze Standard HSA Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950006,Bronze Standard HSA Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950006-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950016,Bronze Standard ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950016-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950016,Bronze Standard ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950016,Bronze Standard ST INN Dep29,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950016-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950018,Bronze Standard ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950018-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950018,Bronze Standard ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950018,Bronze Standard ST INN Dep25,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0950020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950018-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950020,Bronze Standard Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950020-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950020,Bronze Standard Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950020-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0950020,Bronze Standard Child Only ST INN,78124NY095,,NYN011,NYS003,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0950020-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,15-0329043,78124NY0960002,Base Catastrophic ST INN,78124NY096,,NYN011,NYS003,NYF022,Existing,EPO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,No,,No,,https://www.univerahealthcare.com/wps/portal/uv/nysoh-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY0960002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$6,750 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY0990295,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990295-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY0990301,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990301-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY0990303,SimplyBlue Plus Gold 19 NS OON Pediatric Dental Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990303-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY0990309,SimplyBlue Plus Silver 18 NS OON Pediatric Dental Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990309-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020166,Univera Access Platinum 1 NS OON Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020166-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020168,Univera Access Platinum 1 NS OON Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020168-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030336,Univera Access Silver 2 NS OON Dep25 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030336-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040262,Univera Access Bronze 1 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040262-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980068,SimplyBlue Plus Platinum 3 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980068-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980074,SimplyBlue Plus Platinum 3 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980074-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980076,SimplyBlue Plus Platinum 3 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980076-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020174,Univera Access Platinum 1 NS OON Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020174-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020176,Univera Access Platinum 1 NS OON Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF049,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020176-01,Standard Platinum On Exchange Plan,88.87%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020182,Univera Access Platinum 2 NS OON Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020182-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020184,Univera Access Platinum 2 NS OON Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020184-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020190,Univera Access Platinum 2 NS OON Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020190-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020192,Univera Access Platinum 2 NS OON Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF050,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020192-01,Standard Platinum On Exchange Plan,90.36%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$11,000 ",$22000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020214,Univera Access Platinum 3 NS OON Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020214-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020216,Univera Access Platinum 3 NS OON Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020216-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020222,Univera Access Platinum 3 NS OON Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020222-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020224,Univera Access Platinum 3 NS OON Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020224-01,Standard Platinum On Exchange Plan,87.89%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020230,Univera Access Platinum 4 NS OON Dep29 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020230-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020232,Univera Access Platinum 4 NS OON Dep29 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020232-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020238,Univera Access Platinum 4 NS OON Dep25 Adult Vision DP,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020238-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1020240,Univera Access Platinum 4 NS OON Dep25 Adult Vision,78124NY102,,NYN012,NYS003,NYF057,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020240-01,Standard Platinum On Exchange Plan,87.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030294,Univera Access Gold 2 NS OON Dep29 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030294-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030296,Univera Access Gold 2 NS OON Dep29 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030296-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030302,Univera Access Gold 2 NS OON Dep25 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030302-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030304,Univera Access Gold 2 NS OON Dep25 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030304-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,"$14,700 ",$29400 per group,Not Applicable,per group not applicable,"$1,500 ",$3000 per group,0,,,,"$3,000 ",$6000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030326,Univera Access Silver 2 NS OON Dep29 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030326-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030328,Univera Access Silver 2 NS OON Dep29 Adult Vision,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030328-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1030334,Univera Access Silver 2 NS OON Dep25 Adult Vision DP,78124NY103,,NYN012,NYS003,NYF052,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030334-01,Standard Silver On Exchange Plan,71.91%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$15,000 ",$30000 per group,Not Applicable,per group not applicable,"$2,800 ",$5600 per group,0,,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040264,Univera Access Bronze 1 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040264-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040270,Univera Access Bronze 1 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040270-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040272,Univera Access Bronze 1 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF055,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040272-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040278,Univera Access Bronze 2 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040278-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040280,Univera Access Bronze 2 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040280-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040286,Univera Access Bronze 2 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040286-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040288,Univera Access Bronze 2 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF056,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040288-01,Standard Bronze On Exchange Plan,62.64%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$9,000 ",$18000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040406,Univera Access Bronze 4 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040406-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040408,Univera Access Bronze 4 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040408-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040414,Univera Access Bronze 4 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040414-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,15-0329043,78124NY1040416,Univera Access Bronze 4 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF065,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040416-01,Standard Bronze On Exchange Plan,63.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,0%,,,,"$14,000 ",$28000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880008,Platinum Select NS INN Dep29,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880008-01,Standard Platinum On Exchange Plan,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$880 ,$0 ,$60 ,$0 ,$980 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880008,Platinum Select NS INN Dep29,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880008,Platinum Select NS INN Dep29,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880008-03,Limited Cost Sharing Plan Variation,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880010,Platinum Select NS INN Dep25,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880010-01,Standard Platinum On Exchange Plan,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$880 ,$0 ,$60 ,$0 ,$980 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880010,Platinum Select NS INN Dep25,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0880010,Platinum Select NS INN Dep25,78124NY088,,NYN005,NYS001,NYF005,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880010-03,Limited Cost Sharing Plan Variation,89.26%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890014,Gold Select NS INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890014-01,Standard Gold On Exchange Plan,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$930 ,$0 ,$60 ,$750 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890014,Gold Select NS INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890014-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890014,Gold Select NS INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890014-03,Limited Cost Sharing Plan Variation,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890016,Gold Select NS INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890016-01,Standard Gold On Exchange Plan,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$930 ,$0 ,$60 ,$750 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890016,Gold Select NS INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,15-0329043,78124NY0890016,Gold Select NS INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890016-03,Limited Cost Sharing Plan Variation,81.17%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980018,SimplyBlue Plus Platinum 2 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980018-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980020,SimplyBlue Plus Platinum 2 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980020-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980026,SimplyBlue Plus Platinum 2 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980026-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980028,SimplyBlue Plus Platinum 2 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980028-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980050,SimplyBlue Plus Gold 1 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980050-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980052,SimplyBlue Plus Gold 1 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980052-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980058,SimplyBlue Plus Gold 1 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980058-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980060,SimplyBlue Plus Gold 1 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980060-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980066,SimplyBlue Plus Platinum 3 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980066-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980130,SimplyBlue Plus Gold 5 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980130-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980132,SimplyBlue Plus Gold 5 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980132-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980138,SimplyBlue Plus Gold 5 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980138-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980140,SimplyBlue Plus Gold 5 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980140-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980162,SimplyBlue Plus Platinum 5 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980162-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990234,SimplyBlue Plus Platinum 4 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990234-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990236,SimplyBlue Plus Platinum 4 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990236-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990242,SimplyBlue Plus Gold 17 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990242-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980164,SimplyBlue Plus Platinum 5 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980164-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980170,SimplyBlue Plus Platinum 5 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980170-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980172,SimplyBlue Plus Platinum 5 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980172-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980178,SimplyBlue Plus Platinum 6 NS OON Dep29 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980178-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980180,SimplyBlue Plus Platinum 6 NS OON Dep29 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980180-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980186,SimplyBlue Plus Platinum 6 NS OON Dep25 Adult Vision DP FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980186-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0980188,SimplyBlue Plus Platinum 6 NS OON Dep25 Adult Vision FP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980188-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990066,SimplyBlue Plus Gold 13 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990066-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990068,SimplyBlue Plus Gold 13 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990068-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990074,SimplyBlue Plus Gold 13 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990074-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990076,SimplyBlue Plus Gold 13 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990076-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990082,SimplyBlue Plus Gold 14 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990082-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990084,SimplyBlue Plus Gold 14 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990084-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990090,SimplyBlue Plus Gold 14 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990090-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990092,SimplyBlue Plus Gold 14 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990092-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990098,SimplyBlue Plus Silver 6 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990098-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990100,SimplyBlue Plus Silver 6 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990100-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990106,SimplyBlue Plus Silver 6 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990106-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990108,SimplyBlue Plus Silver 6 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990108-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990226,SimplyBlue Plus Platinum 4 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990226-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990228,SimplyBlue Plus Platinum 4 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990228-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990244,SimplyBlue Plus Gold 17 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990244-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990250,SimplyBlue Plus Gold 17 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990250-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990252,SimplyBlue Plus Gold 17 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990252-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990258,SimplyBlue Plus Gold 18 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990258-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990260,SimplyBlue Plus Gold 18 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990260-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990266,SimplyBlue Plus Gold 18 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990266-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040347,Univera Access Silver 3 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040347-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040353,Univera Access Silver 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040353-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990268,SimplyBlue Plus Gold 18 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990268-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY0990290,SimplyBlue Plus Gold 19 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990290-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040225,Univera Access Gold 1 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040225-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040227,Univera Access Gold 1 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040227-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040233,Univera Access Gold 1 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040233-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040235,Univera Access Gold 1 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040235-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040241,Univera Access Silver 1 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040241-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040243,Univera Access Silver 1 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040243-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040249,Univera Access Silver 1 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040249-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040251,Univera Access Silver 1 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040251-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040305,Univera Access Gold 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040305-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040307,Univera Access Gold 3 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040307-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040313,Univera Access Gold 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040313-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040315,Univera Access Gold 3 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040315-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040321,Univera Access Gold 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040321-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040323,Univera Access Gold 4 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040323-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040329,Univera Access Gold 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040329-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040331,Univera Access Gold 4 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040331-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040337,Univera Access Silver 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040337-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040339,Univera Access Silver 3 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040339-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040345,Univera Access Silver 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040345-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040355,Univera Access Silver 4 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040355-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040361,Univera Access Silver 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040361-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040363,Univera Access Silver 4 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040363-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040369,Univera Access Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040369-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040371,Univera Access Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040371-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040229,Univera Access Gold 1 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040229-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040231,Univera Access Gold 1 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040231-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040237,Univera Access Gold 1 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040237-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040377,Univera Access Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040377-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040379,Univera Access Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040379-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040417,Univera Access Silver 5 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040417-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040419,Univera Access Silver 5 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040419-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040425,Univera Access Silver 5 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040425-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,15-0329043,78124NY1040427,Univera Access Silver 5 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040427-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900016,Bronze Standard ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900016-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900016,Bronze Standard ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900016-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900016,Bronze Standard ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900016-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900018,Bronze Standard ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900018-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900018,Bronze Standard ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900018,Bronze Standard ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900018-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900020,Bronze Standard Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900020-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900020,Bronze Standard Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900020-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,Individual,No,15-0329043,78124NY0900020,Bronze Standard Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900020-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990292,SimplyBlue Plus Gold 19 NS OON Dep29 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990292-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990298,SimplyBlue Plus Gold 19 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990298-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990300,SimplyBlue Plus Gold 19 NS OON Dep25 Adult Vision FP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990300-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990306,SimplyBlue Plus Silver 18 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990306-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990308,SimplyBlue Plus Silver 18 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990308-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990310,SimplyBlue Plus Silver 18 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990310-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990312,SimplyBlue Plus Silver 18 NS OON Dep29 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990312-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990314,SimplyBlue Plus Silver 18 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990314-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990316,SimplyBlue Plus Silver 18 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990316-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990318,SimplyBlue Plus Silver 18 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990318-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY0990320,SimplyBlue Plus Silver 18 NS OON Dep25 Adult Vision DP FP,78124NY099,,NYN005,NYS001,NYF063,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990320-01,Standard Silver On Exchange Plan,71.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$13100 per group,0,,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040239,Univera Access Gold 1 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040239-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040245,Univera Access Silver 1 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040245-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040247,Univera Access Silver 1 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040247-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040253,Univera Access Silver 1 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040253-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040421,Univera Access Silver 5 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040421-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040423,Univera Access Silver 5 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040423-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040429,Univera Access Silver 5 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040429-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040431,Univera Access Silver 5 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040431-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040255,Univera Access Silver 1 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040255-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040309,Univera Access Gold 3 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040309-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040311,Univera Access Gold 3 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040311-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040317,Univera Access Gold 3 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040317-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040319,Univera Access Gold 3 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040319-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040325,Univera Access Gold 4 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040325-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040327,Univera Access Gold 4 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040327-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040333,Univera Access Gold 4 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040333-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040335,Univera Access Gold 4 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040335-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040341,Univera Access Silver 3 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040341-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040343,Univera Access Silver 3 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040343-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040349,Univera Access Silver 3 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040349-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040351,Univera Access Silver 3 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040351-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040357,Univera Access Silver 4 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040357-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040359,Univera Access Silver 4 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040359-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040365,Univera Access Silver 4 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040365-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040367,Univera Access Silver 4 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040367-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040373,Univera Access Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040373-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040375,Univera Access Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040375-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040381,Univera Access Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040381-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,15-0329043,78124NY1040383,Univera Access Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040383-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880002,Platinum Standard ST INN Dep29,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880002-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880002,Platinum Standard ST INN Dep29,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880002,Platinum Standard ST INN Dep29,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880002-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880004,Platinum Standard ST INN Dep25,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880004-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980080,SimplyBlue Plus Platinum 3 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980080-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980134,SimplyBlue Plus Gold 5 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980134-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980136,SimplyBlue Plus Gold 5 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980136-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980142,SimplyBlue Plus Gold 5 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980142-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980144,SimplyBlue Plus Gold 5 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF035,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980144-01,Standard Gold On Exchange Plan,81.69%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,200 ",$0 ,$60 ,$0 ,"$2,140 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880004,Platinum Standard ST INN Dep25,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880004,Platinum Standard ST INN Dep25,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0880006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880004-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880006,Platinum Standard Child Only ST INN,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880006-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880006,Platinum Standard Child Only ST INN,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0880006,Platinum Standard Child Only ST INN,78124NY088,,NYN005,NYS001,NYF003,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0880006-03,Limited Cost Sharing Plan Variation,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890002,Gold Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890002-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890002,Gold Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890002,Gold Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890002-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890004,Gold Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890004-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890004,Gold Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890004,Gold Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890004-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890006,Gold Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890006-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890006,Gold Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0890006,Gold Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890006-03,Limited Cost Sharing Plan Variation,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,Individual,No,15-0329043,78124NY0910002,Base Catastrophic ST INN,78124NY091,,NYN005,NYS001,NYF021,Existing,EPO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0910002-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$6,750 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980022,SimplyBlue Plus Platinum 2 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980022-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980024,SimplyBlue Plus Platinum 2 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980024-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980030,SimplyBlue Plus Platinum 2 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980030-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980032,SimplyBlue Plus Platinum 2 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF062,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980032-01,Standard Platinum On Exchange Plan,91.54%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,"$6,350 ",$12700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$340 ,$0 ,$60 ,$0 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980054,SimplyBlue Plus Gold 1 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980054-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980056,SimplyBlue Plus Gold 1 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980056-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980062,SimplyBlue Plus Gold 1 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980062-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980064,SimplyBlue Plus Gold 1 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF036,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980064-01,Standard Gold On Exchange Plan,81.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980070,SimplyBlue Plus Platinum 3 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980070-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980072,SimplyBlue Plus Platinum 3 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980072-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980078,SimplyBlue Plus Platinum 3 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980078-01,Standard Platinum On Exchange Plan,88.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$640 ,$0 ,$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980166,SimplyBlue Plus Platinum 5 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980166-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980168,SimplyBlue Plus Platinum 5 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980168-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990240,SimplyBlue Plus Platinum 4 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990240-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990246,SimplyBlue Plus Gold 17 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990246-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990248,SimplyBlue Plus Gold 17 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990248-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990254,SimplyBlue Plus Gold 17 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990254-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990256,SimplyBlue Plus Gold 17 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990256-01,Standard Gold On Exchange Plan,81.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,"$7,000 ",$14000 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$750 ,$140 ,"$1,830 ",$60 ,$0 ,"$1,440 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990262,SimplyBlue Plus Gold 18 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990262-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980174,SimplyBlue Plus Platinum 5 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980174-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980176,SimplyBlue Plus Platinum 5 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980176-01,Standard Platinum On Exchange Plan,87.53%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980182,SimplyBlue Plus Platinum 6 NS OON Dep29 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980182-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980184,SimplyBlue Plus Platinum 6 NS OON Dep29 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980184-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980190,SimplyBlue Plus Platinum 6 NS OON Dep25 Adult Vision DP,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980190-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0980192,SimplyBlue Plus Platinum 6 NS OON Dep25 Adult Vision,78124NY098,,NYN005,NYS001,NYF040,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980192-01,Standard Platinum On Exchange Plan,86.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990070,SimplyBlue Plus Gold 13 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990070-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990072,SimplyBlue Plus Gold 13 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990072-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990078,SimplyBlue Plus Gold 13 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990078-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990080,SimplyBlue Plus Gold 13 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990080-01,Standard Gold On Exchange Plan,81.64%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,$750 ,$1500 per group,0,,,,$750 ,$1500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990086,SimplyBlue Plus Gold 14 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990086-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990088,SimplyBlue Plus Gold 14 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990088-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990094,SimplyBlue Plus Gold 14 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990094-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990096,SimplyBlue Plus Gold 14 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF042,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990096-01,Standard Gold On Exchange Plan,78.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990102,SimplyBlue Plus Silver 6 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990102-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990104,SimplyBlue Plus Silver 6 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990104-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990110,SimplyBlue Plus Silver 6 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990110-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990112,SimplyBlue Plus Silver 6 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990112-01,Standard Silver On Exchange Plan,71.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990230,SimplyBlue Plus Platinum 4 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990230-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990232,SimplyBlue Plus Platinum 4 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990232-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990238,SimplyBlue Plus Platinum 4 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF038,New,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990238-01,Standard Platinum On Exchange Plan,90.33%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$250 ,$500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990264,SimplyBlue Plus Gold 18 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990264-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990270,SimplyBlue Plus Gold 18 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990270-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990272,SimplyBlue Plus Gold 18 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990272-01,Standard Gold On Exchange Plan,80.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,,,"$6,000 ",$12000 per group,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0,,,,"$1,000 ",$2000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY0990294,SimplyBlue Plus Gold 19 NS OON Dep29 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990294-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040226,Univera Access Gold 1 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040226-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040228,Univera Access Gold 1 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040228-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040234,Univera Access Gold 1 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040234-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040236,Univera Access Gold 1 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040236-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040242,Univera Access Silver 1 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040242-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040244,Univera Access Silver 1 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040244-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040250,Univera Access Silver 1 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040250-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040252,Univera Access Silver 1 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040252-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040306,Univera Access Gold 3 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040306-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040308,Univera Access Gold 3 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040308-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040314,Univera Access Gold 3 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040314-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040316,Univera Access Gold 3 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040316-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040322,Univera Access Gold 4 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040322-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040324,Univera Access Gold 4 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040324-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040330,Univera Access Gold 4 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040330-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040332,Univera Access Gold 4 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040332-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040338,Univera Access Silver 3 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040338-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040340,Univera Access Silver 3 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040340-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040346,Univera Access Silver 3 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040346-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040348,Univera Access Silver 3 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040348-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040354,Univera Access Silver 4 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040354-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040356,Univera Access Silver 4 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040356-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040362,Univera Access Silver 4 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040362-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040364,Univera Access Silver 4 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040364-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040370,Univera Access Bronze 3 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040370-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040372,Univera Access Bronze 3 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040372-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040378,Univera Access Bronze 3 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040378-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040380,Univera Access Bronze 3 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040380-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040418,Univera Access Silver 5 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040418-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040420,Univera Access Silver 5 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040420-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040232,Univera Access Gold 1 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040232-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040238,Univera Access Gold 1 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040238-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040426,Univera Access Silver 5 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040426-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,15-0329043,78124NY1040428,Univera Access Silver 5 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040428-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890008,Silver Standard ST INN Dep29,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890008-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890010,Silver Standard ST INN Dep25,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0890012,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890010-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-04,73% AV Level Silver Plan,73.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$1,710 ",$0 ,$60 ,"$1,350 ","$1,360 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-05,87% AV Level Silver Plan,87.05%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$250 ,$500 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,$420 ,$0 ,$60 ,$250 ,$960 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0890012,Silver Standard Child Only ST INN,78124NY089,,NYN005,NYS001,NYF009,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890012-06,94% AV Level Silver Plan,93.94%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$200 ,$0 ,$60 ,$0 ,$750 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900002,Bronze Standard HSA ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900002-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900002,Bronze Standard HSA ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900002-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900002,Bronze Standard HSA ST INN Dep29,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900002-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900004,Bronze Standard HSA ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900004-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900004,Bronze Standard HSA ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900004,Bronze Standard HSA ST INN Dep25,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,78124NY0900006,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900004-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900006,Bronze Standard HSA Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900006-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900006,Bronze Standard HSA Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900006-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,Individual,No,15-0329043,78124NY0900006,Bronze Standard HSA Child Only ST INN,78124NY090,,NYN005,NYS001,NYF007,Existing,EPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0900006-03,Limited Cost Sharing Plan Variation,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY0990296,SimplyBlue Plus Gold 19 NS OON Dep29 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990296-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY0990302,SimplyBlue Plus Gold 19 NS OON Dep25 Adult Vision DP,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990302-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY0990304,SimplyBlue Plus Gold 19 NS OON Dep25 Adult Vision,78124NY099,,NYN005,NYS001,NYF044,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990304-01,Standard Gold On Exchange Plan,77.32%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,"$6,850 ",$13700 per group,Not Applicable,per group not applicable,"$2,250 ",$4500 per group,0,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040230,Univera Access Gold 1 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040230-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040240,Univera Access Gold 1 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF051,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040240-01,Standard Gold On Exchange Plan,80.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$5,600 ",$11200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040246,Univera Access Silver 1 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040246-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040248,Univera Access Silver 1 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040248-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040254,Univera Access Silver 1 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040254-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040256,Univera Access Silver 1 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF064,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040256-01,Standard Silver On Exchange Plan,71.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0%,,,,"$4,400 ",$8800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040424,Univera Access Silver 5 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040424-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040430,Univera Access Silver 5 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040430-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040432,Univera Access Silver 5 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040432-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040310,Univera Access Gold 3 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040310-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040312,Univera Access Gold 3 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040312-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040318,Univera Access Gold 3 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040318-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040320,Univera Access Gold 3 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040320-01,Standard Gold On Exchange Plan,78.14%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,400 ",$6800 per group,,,"$6,800 ",$13600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,0%,,,,"$3,400 ",$6800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040326,Univera Access Gold 4 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040326-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040328,Univera Access Gold 4 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040328-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040334,Univera Access Gold 4 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040334-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040336,Univera Access Gold 4 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040336-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040342,Univera Access Silver 3 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040342-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040344,Univera Access Silver 3 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040344-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040350,Univera Access Silver 3 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040350-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040352,Univera Access Silver 3 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040352-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$6,400 ",$12800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040358,Univera Access Silver 4 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040358-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040360,Univera Access Silver 4 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040360-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040366,Univera Access Silver 4 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040366-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040368,Univera Access Silver 4 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF058,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040368-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$7,200 ",$14400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040374,Univera Access Bronze 3 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040374-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040376,Univera Access Bronze 3 NS OON Dep29 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040376-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040382,Univera Access Bronze 3 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040382-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040384,Univera Access Bronze 3 NS OON Dep25 Adult Vision Preventive Rx,78124NY104,,NYN012,NYS003,NYF059,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040384-01,Standard Bronze On Exchange Plan,64.98%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$13,300 ",$26600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,15-0329043,78124NY1040422,Univera Access Silver 5 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY104,,NYN012,NYS003,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1040422-01,Standard Silver On Exchange Plan,70.44%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$13,100 ",$26200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890018-01,Standard Gold On Exchange Plan,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890018-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890018,Gold Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890018-03,Limited Cost Sharing Plan Variation,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890020-01,Standard Gold On Exchange Plan,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890020-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890020,Gold Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890020-03,Limited Cost Sharing Plan Variation,79.52%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$650 ,$1300 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-01,Standard Silver On Exchange Plan,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000155,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000155-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000161,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000161-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000163,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000163-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-03,Limited Cost Sharing Plan Variation,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-04,73% AV Level Silver Plan,73.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-05,87% AV Level Silver Plan,87.57%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$400 ,$800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890024,Silver Standard Plus 3 ST3PCP ST INN Dep29,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890024-06,94% AV Level Silver Plan,93.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-01,Standard Silver On Exchange Plan,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-03,Limited Cost Sharing Plan Variation,71.82%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,750 ",$15500 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,350 ",$4700 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-04,73% AV Level Silver Plan,73.86%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,"$1,900 ",$3800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-05,87% AV Level Silver Plan,87.57%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$400 ,$800 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,Individual,No,15-0329043,78124NY0890026,Silver Standard Plus 3 ST3PCP ST INN Dep25,78124NY089,,NYN005,NYS001,NYF060,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0890026-06,94% AV Level Silver Plan,93.83%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000017,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000017-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000019,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000019-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000025,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000025-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000027,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000027-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000049,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000049-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000051,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000051-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000057,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000057-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000059,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000059-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000097,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000097-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000099,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000099-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000105,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000105-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000107,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000107-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000145,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000145-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000147,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000147-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000153,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000153-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000169,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000169-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000171,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000171-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000177,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000177-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000179,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000179-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000185,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000185-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000187,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000187-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000291,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000291-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000297,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000297-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000193,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000193-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000195,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000195-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000201,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000201-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000203,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000203-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000225,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000225-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000227,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000227-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000233,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000233-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000235,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000235-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000241,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000241-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000243,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000243-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000249,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000249-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000251,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000251-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000257,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000257-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000259,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000259-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000265,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000265-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000267,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000267-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000273,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000273-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000275,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000275-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000281,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000281-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000283,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000283-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000289,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000289-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000299,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000299-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1000303,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000303-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1080001,Univera Healthcare HMO NS INN Pediatric Dental Dep29 DP FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080001-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1080003,Univera Healthcare HMO NS INN Pediatric Dental Dep29 FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080003-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1080009,Univera Healthcare HMO NS INN Pediatric Dental Dep25 DP FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080009-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,15-0329043,78124NY1080011,Univera Healthcare HMO NS INN Pediatric Dental Dep25 FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080011-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000021,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000021-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000189,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000189-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000023,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000023-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000029,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000029-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000031,SimplyBlue Plus Gold 6 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000031-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000053,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000053-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000055,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000055-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000061,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000061-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000063,SimplyBlue Plus Silver 2 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000063-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000101,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000101-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000103,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000103-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000109,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000109-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000111,SimplyBlue Plus Silver 4 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000111-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000149,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000149-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000151,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000151-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000157,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000157-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000159,SimplyBlue Plus Bronze 3 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000159-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000165,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000165-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000167,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000167-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000173,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000173-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000175,SimplyBlue Plus Bronze 4 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000175-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000181,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000181-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000183,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000183-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000191,SimplyBlue Plus Silver 14 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000191-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000197,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000197-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000199,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000199-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000205,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000205-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000207,SimplyBlue Plus Bronze 5 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000207-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1080013,Univera Healthcare HMO NS INN Pediatric Dental Dep25 DP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080013-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1080015,Univera Healthcare HMO NS INN Pediatric Dental Dep25,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080015-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130002,CNY Preferred Gold NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130002-01,Standard Gold On Exchange Plan,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000229,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000229-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000231,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000231-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000237,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000237-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000239,SimplyBlue Plus Gold 20 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000239-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000245,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000245-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000247,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000247-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000253,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000253-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000255,SimplyBlue Plus Silver 16 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000255-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000261,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000261-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000263,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000263-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000269,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000269-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000271,SimplyBlue Plus Silver 17 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000271-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000277,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000277-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000279,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000279-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000285,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000285-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000287,SimplyBlue Plus Bronze 6 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000287-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000293,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000293-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000295,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000295-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1000301,SimplyBlue Plus Silver 19 NS OON Pediatric Dental Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000301-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1080005,Univera Healthcare HMO NS INN Pediatric Dental Dep29 DP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080005-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,15-0329043,78124NY1080007,Univera Healthcare HMO NS INN Pediatric Dental Dep29,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080007-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130002,CNY Preferred Gold NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130002-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130002,CNY Preferred Gold NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130002-03,Limited Cost Sharing Plan Variation,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130004,CNY Preferred Gold NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130004-01,Standard Gold On Exchange Plan,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130004,CNY Preferred Gold NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130004-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130004,CNY Preferred Gold NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF017,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130004-03,Limited Cost Sharing Plan Variation,81.45%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,"$6,350 ",$12700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$930 ,$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000290,SimplyBlue Plus Silver 19 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000290-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000152,SimplyBlue Plus Bronze 3 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000152-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000288,SimplyBlue Plus Bronze 6 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000288-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020149,Univera Access Standard Platinum X ST OON Pediatric Dental Dep29 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020149-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020151,Univera Access Standard Platinum X ST OON Pediatric Dental Dep29,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020151-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-01,Standard Silver On Exchange Plan,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-03,Limited Cost Sharing Plan Variation,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-04,73% AV Level Silver Plan,73.91%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,"$5,750 ",$11500 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-05,87% AV Level Silver Plan,87.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,250 ",$380 ,$0 ,$60 ,"$1,250 ",$840 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130006,CNY Preferred Silver NS INN Dep29 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130006-06,94% AV Level Silver Plan,94.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$150 ,$0 ,$60 ,$0 ,"$1,550 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-01,Standard Silver On Exchange Plan,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-03,Limited Cost Sharing Plan Variation,71.76%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,"$6,850 ",$13700 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-04,73% AV Level Silver Plan,73.91%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,"$5,750 ",$11500 per group,$0 ,$0 per group,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0,,,0,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,0%,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,460 ",$0 ,$60 ,"$2,000 ","$1,260 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-05,87% AV Level Silver Plan,87.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,250 ",$380 ,$0 ,$60 ,"$1,250 ",$840 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,10,Individual,No,15-0329043,78124NY1130008,CNY Preferred Silver NS INN Dep25 Tiered Network,78124NY113,,NYN009,NYS007,NYF013,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://excellusbcbs.com/wps/portal/xl/nysoh-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1130008-06,94% AV Level Silver Plan,94.00%,,No,Yes,Yes,66%,34%,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0%,,,0%,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$150 ,$0 ,$60 ,$0 ,"$1,550 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000018,SimplyBlue Plus Gold 6 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000018-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000020,SimplyBlue Plus Gold 6 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000020-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000026,SimplyBlue Plus Gold 6 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000026-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000028,SimplyBlue Plus Gold 6 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000028-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000050,SimplyBlue Plus Silver 2 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000050-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000052,SimplyBlue Plus Silver 2 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000052-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000058,SimplyBlue Plus Silver 2 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000058-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000060,SimplyBlue Plus Silver 2 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000060-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000098,SimplyBlue Plus Silver 4 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000098-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000100,SimplyBlue Plus Silver 4 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000100-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000106,SimplyBlue Plus Silver 4 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000106-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000108,SimplyBlue Plus Silver 4 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000108-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000146,SimplyBlue Plus Bronze 3 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000146-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000148,SimplyBlue Plus Bronze 3 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000148-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000154,SimplyBlue Plus Bronze 3 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000154-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000156,SimplyBlue Plus Bronze 3 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000156-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000162,SimplyBlue Plus Bronze 4 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000162-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000164,SimplyBlue Plus Bronze 4 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000164-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000170,SimplyBlue Plus Bronze 4 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000170-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000172,SimplyBlue Plus Bronze 4 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000172-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000178,SimplyBlue Plus Silver 14 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000178-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000180,SimplyBlue Plus Silver 14 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000180-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000186,SimplyBlue Plus Silver 14 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000186-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000188,SimplyBlue Plus Silver 14 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000188-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000194,SimplyBlue Plus Bronze 5 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000194-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000196,SimplyBlue Plus Bronze 5 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000196-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000202,SimplyBlue Plus Bronze 5 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000202-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000204,SimplyBlue Plus Bronze 5 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000204-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000226,SimplyBlue Plus Gold 20 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000226-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000228,SimplyBlue Plus Gold 20 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000228-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000234,SimplyBlue Plus Gold 20 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000234-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000236,SimplyBlue Plus Gold 20 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000236-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000242,SimplyBlue Plus Silver 16 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000242-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000244,SimplyBlue Plus Silver 16 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000244-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000250,SimplyBlue Plus Silver 16 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000250-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000252,SimplyBlue Plus Silver 16 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000252-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000258,SimplyBlue Plus Silver 17 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000258-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000260,SimplyBlue Plus Silver 17 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000260-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000266,SimplyBlue Plus Silver 17 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000266-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000268,SimplyBlue Plus Silver 17 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000268-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000274,SimplyBlue Plus Bronze 6 NS OON Dep29 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000274-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000276,SimplyBlue Plus Bronze 6 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000276-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000282,SimplyBlue Plus Bronze 6 NS OON Dep25 Adult Vision DP FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000282-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000284,SimplyBlue Plus Bronze 6 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000284-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000292,SimplyBlue Plus Silver 19 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000292-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000294,SimplyBlue Plus Silver 19 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000294-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000296,SimplyBlue Plus Silver 19 NS OON Dep29 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000296-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1000298,SimplyBlue Plus Silver 19 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000298-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1080002,Univera Healthcare HMO NS INN Dep29 DP FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080002-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1080004,Univera Healthcare HMO NS INN Dep29 FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080004-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1080010,Univera Healthcare HMO NS INN Dep25 DP FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080010-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,15-0329043,78124NY1080012,Univera Healthcare HMO NS INN Dep25 FP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080012-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1000300,SimplyBlue Plus Silver 19 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000300-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1000302,SimplyBlue Plus Silver 19 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000302-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1000304,SimplyBlue Plus Silver 19 NS OON Dep25 Adult Vision FP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000304-01,Standard Silver On Exchange Plan,70.65%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,250 ",$4500 per group,0%,,,,"$2,250 ",$4500 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1080006,Univera Healthcare HMO NS INN Dep29 DP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080006-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1080008,Univera Healthcare HMO NS INN Dep29,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080008-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1080014,Univera Healthcare HMO NS INN Dep25 DP,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080014-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,15-0329043,78124NY1080016,Univera Healthcare HMO NS INN Dep25,78124NY108,,NYN001,NYS004,NYF048,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1080016-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000022,SimplyBlue Plus Gold 6 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000022-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000024,SimplyBlue Plus Gold 6 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000024-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000030,SimplyBlue Plus Gold 6 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000030-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000032,SimplyBlue Plus Gold 6 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000032-01,Standard Gold On Exchange Plan,81.02%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,400 ",$2800 per group,0%,,,,"$1,400 ",$2800 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000054,SimplyBlue Plus Silver 2 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000054-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000056,SimplyBlue Plus Silver 2 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000056-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000062,SimplyBlue Plus Silver 2 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000062-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000064,SimplyBlue Plus Silver 2 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000064-01,Standard Silver On Exchange Plan,71.75%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,"$6,650 ",$13300 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,0%,,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,"$2,000 ",$10 ,"$2,120 ",$60 ,"$2,000 ",$70 ,$990 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000102,SimplyBlue Plus Silver 4 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000102-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000104,SimplyBlue Plus Silver 4 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000104-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000110,SimplyBlue Plus Silver 4 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000110-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000112,SimplyBlue Plus Silver 4 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000112-01,Standard Silver On Exchange Plan,71.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0%,,,,"$2,500 ",$5000 per group,Not Applicable,per group not applicable,"$2,500 ",$10 ,"$1,510 ",$60 ,"$2,500 ",$70 ,$670 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000150,SimplyBlue Plus Bronze 3 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000150-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000158,SimplyBlue Plus Bronze 3 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000158-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000160,SimplyBlue Plus Bronze 3 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF034,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000160-01,Standard Bronze On Exchange Plan,62.35%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0%,,,,"$5,000 ",$10000 per group,Not Applicable,per group not applicable,"$5,000 ",$0 ,"$1,550 ",$60 ,"$5,000 ",$60 ,"$1,040 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000166,SimplyBlue Plus Bronze 4 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000166-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000168,SimplyBlue Plus Bronze 4 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000168-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000174,SimplyBlue Plus Bronze 4 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000174-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000176,SimplyBlue Plus Bronze 4 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF045,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000176-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0%,,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000182,SimplyBlue Plus Silver 14 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000182-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000184,SimplyBlue Plus Silver 14 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000184-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000190,SimplyBlue Plus Silver 14 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000190-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000192,SimplyBlue Plus Silver 14 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000192-01,Standard Silver On Exchange Plan,69.56%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,0%,,,,"$2,800 ",$5600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000198,SimplyBlue Plus Bronze 5 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000198-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000200,SimplyBlue Plus Bronze 5 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000200-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000206,SimplyBlue Plus Bronze 5 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000206-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000208,SimplyBlue Plus Bronze 5 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF031,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000208-01,Standard Bronze On Exchange Plan,62.33%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000230,SimplyBlue Plus Gold 20 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000230-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000232,SimplyBlue Plus Gold 20 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000232-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000238,SimplyBlue Plus Gold 20 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000238-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000240,SimplyBlue Plus Gold 20 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000240-01,Standard Gold On Exchange Plan,77.21%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,800 ",$3600 per group,0%,,,,"$1,800 ",$3600 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000246,SimplyBlue Plus Silver 16 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000246-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000248,SimplyBlue Plus Silver 16 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000248-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000254,SimplyBlue Plus Silver 16 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000254-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000256,SimplyBlue Plus Silver 16 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000256-01,Standard Silver On Exchange Plan,68.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,200 ",$6400 per group,0%,,,,"$3,200 ",$6400 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000262,SimplyBlue Plus Silver 17 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000262-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000264,SimplyBlue Plus Silver 17 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000264-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000270,SimplyBlue Plus Silver 17 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000270-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000272,SimplyBlue Plus Silver 17 NS OON Dep25 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF041,New,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000272-01,Standard Silver On Exchange Plan,67.26%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,600 ",$7200 per group,0%,,,,"$3,600 ",$7200 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000278,SimplyBlue Plus Bronze 6 NS OON Dep29 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000278-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000280,SimplyBlue Plus Bronze 6 NS OON Dep29 Adult Vision Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000280-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1000286,SimplyBlue Plus Bronze 6 NS OON Dep25 Adult Vision DP Preventive Rx,78124NY100,,NYN005,NYS001,NYF043,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000286-01,Standard Bronze On Exchange Plan,64.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,0%,,,,"$4,500 ",$9000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020001,Univera Access Standard Platinum ST OON Pediatric Dental Dep29 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020001-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020003,Univera Access Standard Platinum ST OON Pediatric Dental Dep29 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020003-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020009,Univera Access Standard Platinum ST OON Pediatric Dental Dep25 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020009-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020011,Univera Access Standard Platinum ST OON Pediatric Dental Dep25 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020011-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020145,Univera Access Standard Platinum X ST OON Pediatric Dental Dep29 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020145-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020147,Univera Access Standard Platinum X ST OON Pediatric Dental Dep29 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020147-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020153,Univera Access Standard Platinum X ST OON Pediatric Dental Dep25 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020153-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1020155,Univera Access Standard Platinum X ST OON Pediatric Dental Dep25 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020155-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030001,Univera Access Standard Silver ST OON Pediatric Dental Dep29 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030001-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030003,Univera Access Standard Silver ST OON Pediatric Dental Dep29 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030003-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030009,Univera Access Standard Silver ST OON Pediatric Dental Dep25 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030009-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030011,Univera Access Standard Silver ST OON Pediatric Dental Dep25 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030011-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030033,Univera Access Standard Gold ST OON Pediatric Dental Dep29 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030033-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030035,Univera Access Standard Gold ST OON Pediatric Dental Dep29 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030035-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030041,Univera Access Standard Gold ST OON Pediatric Dental Dep25 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030041-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1030043,Univera Access Standard Gold ST OON Pediatric Dental Dep25 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030043-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040001,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep29 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040001-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040003,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep29 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040003-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040009,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep25 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040009-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040011,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep25 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040011-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040209,Univera Access Standard Bronze ST OON Pediatric Dental Dep29 DP FP,78124NY104,,NYN012,NYS003,NYF047,New,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040209-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040211,Univera Access Standard Bronze ST OON Pediatric Dental Dep29 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040211-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040217,Univera Access Standard Bronze ST OON Pediatric Dental Dep25 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040217-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,15-0329043,78124NY1040219,Univera Access Standard Bronze ST OON Pediatric Dental Dep25 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040219-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020005,Univera Access Standard Platinum ST OON Pediatric Dental Dep29 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020005-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020007,Univera Access Standard Platinum ST OON Pediatric Dental Dep29,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020007-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020013,Univera Access Standard Platinum ST OON Pediatric Dental Dep25 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020013-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020015,Univera Access Standard Platinum ST OON Pediatric Dental Dep25,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020015-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020157,Univera Access Standard Platinum X ST OON Pediatric Dental Dep25 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020157-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1020159,Univera Access Standard Platinum X ST OON Pediatric Dental Dep25,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020159-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030005,Univera Access Standard Silver ST OON Pediatric Dental Dep29 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030005-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030007,Univera Access Standard Silver ST OON Pediatric Dental Dep29,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030007-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030013,Univera Access Standard Silver ST OON Pediatric Dental Dep25 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030013-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030015,Univera Access Standard Silver ST OON Pediatric Dental Dep25,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030015-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030037,Univera Access Standard Gold ST OON Pediatric Dental Dep29 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030037-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030039,Univera Access Standard Gold ST OON Pediatric Dental Dep29,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030039-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030045,Univera Access Standard Gold ST OON Pediatric Dental Dep25 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030045-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1030047,Univera Access Standard Gold ST OON Pediatric Dental Dep25,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030047-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040005,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep29 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040005-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040007,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep29,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040007-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020146,Univera Access Standard Platinum X ST OON Dep29 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020146-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020152,Univera Access Standard Platinum X ST OON Dep29,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020152-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020158,Univera Access Standard Platinum X ST OON Dep25 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020158-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020160,Univera Access Standard Platinum X ST OON Dep25,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020160-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040013,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep25 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040013-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040015,Univera Access Standard Bronze HSA ST OON Pediatric Dental Dep25,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040015-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040213,Univera Access Standard Bronze ST OON Pediatric Dental Dep29 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040213-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040215,Univera Access Standard Bronze ST OON Pediatric Dental Dep29,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040215-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040221,Univera Access Standard Bronze ST OON Pediatric Dental Dep25 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040221-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1040223,Univera Access Standard Bronze ST OON Pediatric Dental Dep25,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040223-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1070001,Excellus BCBS HMO NS INN Pediatric Dental Dep29 DP FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070001-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1070003,Excellus BCBS HMO NS INN Pediatric Dental Dep29 FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070003-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1070009,Excellus BCBS HMO NS INN Pediatric Dental Dep25 DP FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070009-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,15-0329043,78124NY1070011,Excellus BCBS HMO NS INN Pediatric Dental Dep25 FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070011-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020002,Univera Access Standard Platinum ST OON Dep29 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020002-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020004,Univera Access Standard Platinum ST OON Dep29 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020004-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020010,Univera Access Standard Platinum ST OON Dep25 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020010-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020012,Univera Access Standard Platinum ST OON Dep25 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020012-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020148,Univera Access Standard Platinum X ST OON Dep29 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020148-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020154,Univera Access Standard Platinum X ST OON Dep25 DP FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020154-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1020156,Univera Access Standard Platinum X ST OON Dep25 FP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020156-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030002,Univera Access Standard Silver ST OON Dep29 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030002-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030004,Univera Access Standard Silver ST OON Dep29 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030004-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030010,Univera Access Standard Silver ST OON Dep25 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030010-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030012,Univera Access Standard Silver ST OON Dep25 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030012-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030034,Univera Access Standard Gold ST OON Dep29 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030034-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030036,Univera Access Standard Gold ST OON Dep29 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030036-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030042,Univera Access Standard Gold ST OON Dep25 DP FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030042-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1030044,Univera Access Standard Gold ST OON Dep25 FP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030044-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040002,Univera Access Standard Bronze HSA ST OON Dep29 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040002-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040004,Univera Access Standard Bronze HSA ST OON Dep29 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040004-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040010,Univera Access Standard Bronze HSA ST OON Dep25 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040010-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040012,Univera Access Standard Bronze HSA ST OON Dep25 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040012-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040210,Univera Access Standard Bronze ST OON Dep29 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040210-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040212,Univera Access Standard Bronze ST OON Dep29 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040212-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040218,Univera Access Standard Bronze ST OON Dep25 DP FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040218-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1040220,Univera Access Standard Bronze ST OON Dep25 FP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040220-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1070005,Excellus BCBS HMO NS INN Pediatric Dental Dep29 DP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070005-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1070007,Excellus BCBS HMO NS INN Pediatric Dental Dep29,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070007-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1070013,Excellus BCBS HMO NS INN Pediatric Dental Dep25 DP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070013-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,15-0329043,78124NY1070015,Excellus BCBS HMO NS INN Pediatric Dental Dep25,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070015-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020006,Univera Access Standard Platinum ST OON Dep29 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020006-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020008,Univera Access Standard Platinum ST OON Dep29,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020008-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020014,Univera Access Standard Platinum ST OON Dep25 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020014-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020016,Univera Access Standard Platinum ST OON Dep25,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020016-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1020150,Univera Access Standard Platinum X ST OON Dep29 DP,78124NY102,,NYN012,NYS003,NYF046,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1020150-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030006,Univera Access Standard Silver ST OON Dep29 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030006-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030008,Univera Access Standard Silver ST OON Dep29,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030008-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030014,Univera Access Standard Silver ST OON Dep25 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030014-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980003,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep29 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980003-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990012,SimplyBlue Plus Standard Silver ST OON Dep25 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990012-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990034,SimplyBlue Plus Standard Gold ST OON Dep29 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990034-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990036,SimplyBlue Plus Standard Gold ST OON Dep29 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990036-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000016,SimplyBlue Plus Standard Bronze HSA ST OON Dep25,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000016-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030016,Univera Access Standard Silver ST OON Dep25,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030016-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030038,Univera Access Standard Gold ST OON Dep29 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030038-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030040,Univera Access Standard Gold ST OON Dep29,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030040-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030046,Univera Access Standard Gold ST OON Dep25 DP,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030046-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1030048,Univera Access Standard Gold ST OON Dep25,78124NY103,,NYN012,NYS003,NYF048,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1030048-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040006,Univera Access Standard Bronze HSA ST OON Dep29 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040006-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040008,Univera Access Standard Bronze HSA ST OON Dep29,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040008-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040014,Univera Access Standard Bronze HSA ST OON Dep25 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040014-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040016,Univera Access Standard Bronze HSA ST OON Dep25,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040016-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$6,550 ",$13100 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040214,Univera Access Standard Bronze ST OON Dep29 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040214-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040216,Univera Access Standard Bronze ST OON Dep29,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040216-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040222,Univera Access Standard Bronze ST OON Dep25 DP,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040222-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1040224,Univera Access Standard Bronze ST OON Dep25,78124NY104,,NYN012,NYS003,NYF047,Existing,PPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,See contract for covered care,No,,https://www.univerahealthcare.com/wps/portal/uv/shop-premium-payment,,https://www.univerahealthcare.com/rxlist,78124NY1040224-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$7,600 ",$15200 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1070002,Excellus BCBS HMO NS INN Dep29 DP FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070002-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1070004,Excellus BCBS HMO NS INN Dep29 FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070004-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1070010,Excellus BCBS HMO NS INN Dep25 DP FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070010-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,15-0329043,78124NY1070012,Excellus BCBS HMO NS INN Dep25 FP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070012-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,15-0329043,78124NY1070006,Excellus BCBS HMO NS INN Dep29 DP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070006-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,15-0329043,78124NY1070008,Excellus BCBS HMO NS INN Dep29,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070008-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,15-0329043,78124NY1070014,Excellus BCBS HMO NS INN Dep25 DP,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070014-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,15-0329043,78124NY1070016,Excellus BCBS HMO NS INN Dep25,78124NY107,,NYN004,NYS002,NYF032,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1070016-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$0 ,$0 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980001,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep29 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980001-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980009,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep25 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980009-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980011,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep25 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980011-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980145,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep29 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980145-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980147,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep29 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980147-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980153,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep25 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980153-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0980155,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep25 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980155-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990001,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep29 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990001-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990003,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep29 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990003-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990009,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep25 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990009-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990011,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep25 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990011-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990033,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep29 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990033-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990035,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep29 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990035-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990041,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep25 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990041-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY0990043,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep25 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990043-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000001,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep29 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000001-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000003,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep29 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000003-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000009,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep25 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000009-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000011,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep25 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000011-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000209,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep29 DP FP,78124NY100,,NYN005,NYS001,NYF030,New,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000209-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000211,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep29 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000211-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000217,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep25 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000217-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,15-0329043,78124NY1000219,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep25 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000219-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980005,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep29 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980005-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980007,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep29,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980007-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980013,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep25 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980013-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980015,SimplyBlue Plus Standard Platinum ST OON Pediatric Dental Dep25,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980015-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980149,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep29 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980149-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980151,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep29,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980151-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980157,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep25 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980157-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0980159,SimplyBlue Plus Standard Platinum X ST OON Pediatric Dental Dep25,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980159-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990005,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep29 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990005-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990007,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep29,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990007-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990013,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep25 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990013-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990015,SimplyBlue Plus Standard Silver ST OON Pediatric Dental Dep25,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990015-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990037,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep29 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990037-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990039,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep29,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990039-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990045,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep25 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990045-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY0990047,SimplyBlue Plus Standard Gold ST OON Pediatric Dental Dep25,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990047-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000005,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep29 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000005-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000007,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep29,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000007-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000013,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep25 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000013-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000015,SimplyBlue Plus Standard Bronze HSA ST OON Pediatric Dental Dep25,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000015-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000213,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep29 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000213-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000215,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep29,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000215-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000221,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep25 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000221-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,15-0329043,78124NY1000223,SimplyBlue Plus Standard Bronze ST OON Pediatric Dental Dep25,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000223-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$60 ,$0 ,$0 ,$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980002,SimplyBlue Plus Standard Platinum ST OON Dep29 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980002-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980004,SimplyBlue Plus Standard Platinum ST OON Dep29 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980004-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980010,SimplyBlue Plus Standard Platinum ST OON Dep25 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980010-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980012,SimplyBlue Plus Standard Platinum ST OON Dep25 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980012-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980146,SimplyBlue Plus Standard Platinum X ST OON Dep29 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980146-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980148,SimplyBlue Plus Standard Platinum X ST OON Dep29 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980148-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980154,SimplyBlue Plus Standard Platinum X ST OON Dep25 DP FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980154-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0980156,SimplyBlue Plus Standard Platinum X ST OON Dep25 FP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980156-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990002,SimplyBlue Plus Standard Silver ST OON Dep29 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990002-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990004,SimplyBlue Plus Standard Silver ST OON Dep29 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990004-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990010,SimplyBlue Plus Standard Silver ST OON Dep25 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990010-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990042,SimplyBlue Plus Standard Gold ST OON Dep25 DP FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990042-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY0990044,SimplyBlue Plus Standard Gold ST OON Dep25 FP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990044-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000002,SimplyBlue Plus Standard Bronze HSA ST OON Dep29 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000002-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000004,SimplyBlue Plus Standard Bronze HSA ST OON Dep29 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000004-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000010,SimplyBlue Plus Standard Bronze HSA ST OON Dep25 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000010-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000012,SimplyBlue Plus Standard Bronze HSA ST OON Dep25 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000012-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000210,SimplyBlue Plus Standard Bronze ST OON Dep29 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000210-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000212,SimplyBlue Plus Standard Bronze ST OON Dep29 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000212-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000218,SimplyBlue Plus Standard Bronze ST OON Dep25 DP FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000218-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,15-0329043,78124NY1000220,SimplyBlue Plus Standard Bronze ST OON Dep25 FP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000220-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980006,SimplyBlue Plus Standard Platinum ST OON Dep29 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980006-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980008,SimplyBlue Plus Standard Platinum ST OON Dep29,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980008-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980014,SimplyBlue Plus Standard Platinum ST OON Dep25 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980014-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980016,SimplyBlue Plus Standard Platinum ST OON Dep25,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980016-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980150,SimplyBlue Plus Standard Platinum X ST OON Dep29 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980150-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980152,SimplyBlue Plus Standard Platinum X ST OON Dep29,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980152-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980158,SimplyBlue Plus Standard Platinum X ST OON Dep25 DP,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980158-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0980160,SimplyBlue Plus Standard Platinum X ST OON Dep25,78124NY098,,NYN005,NYS001,NYF029,Existing,PPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0980160-01,Standard Platinum On Exchange Plan,88.01%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,"$2,000 ",$4000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0,,,,$500 ,$1000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$670 ,$0 ,$60 ,$0 ,"$1,020 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990006,SimplyBlue Plus Standard Silver ST OON Dep29 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990006-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990008,SimplyBlue Plus Standard Silver ST OON Dep29,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990008-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990014,SimplyBlue Plus Standard Silver ST OON Dep25 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990014-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990016,SimplyBlue Plus Standard Silver ST OON Dep25,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990016-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0,,,,"$1,700 ",$3400 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$1,710 ",$0 ,$60 ,"$1,700 ","$1,290 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990038,SimplyBlue Plus Standard Gold ST OON Dep29 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990038-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990040,SimplyBlue Plus Standard Gold ST OON Dep29,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990040-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990046,SimplyBlue Plus Standard Gold ST OON Dep25 DP,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990046-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY0990048,SimplyBlue Plus Standard Gold ST OON Dep25,78124NY099,,NYN005,NYS001,NYF032,Existing,PPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY0990048-01,Standard Gold On Exchange Plan,79.78%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$600 ,$1200 per group,0,,,,$600 ,$1200 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0%,,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,180 ",$0 ,$60 ,$600 ,"$1,330 ",$0 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000006,SimplyBlue Plus Standard Bronze HSA ST OON Dep29 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000006-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000008,SimplyBlue Plus Standard Bronze HSA ST OON Dep29,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000008-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000014,SimplyBlue Plus Standard Bronze HSA ST OON Dep25 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000014-01,Standard Bronze On Exchange Plan,62.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,"$7,500 ",$15000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0%,,,,"$5,500 ",$11000 per group,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,050 ",$60 ,"$5,500 ",$50 ,$800 ,$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000214,SimplyBlue Plus Standard Bronze ST OON Dep29 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000214-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000216,SimplyBlue Plus Standard Bronze ST OON Dep29,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000216-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000222,SimplyBlue Plus Standard Bronze ST OON Dep25 DP,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000222-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,"Excellus Health Plan, Inc.",78124,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,15-0329043,78124NY1000224,SimplyBlue Plus Standard Bronze ST OON Dep25,78124NY100,,NYN005,NYS001,NYF030,Existing,PPO,Expanded Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Services Only,Yes,BlueCard Worldwide,Yes,,https://www.excellusbcbs.com/wps/portal/xl/shop-premium-payment,,https://www.excellusbcbs.com/rxlist,78124NY1000224-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,0%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,"$4,000 ",$0 ,"$3,600 ",$60 ,"$4,000 ",$90 ,"$1,510 ",$60 
2019,NY,Solstice Health Insurance Company,85427,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,27-1395245,85427NY0010001,EssentialSmile 111 ST INN Pediatric,85427NY001,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,http://www.solsticebenefits.com/paymybillcc/index.htm,,,85427NY0010001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$50 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,Solstice Health Insurance Company,85427,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),Yes,27-1395245,85427NY0020001,EssentialSmile 112 ST INN Pediatric,85427NY002,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,http://www.solsticebenefits.com/paymybillcc/index.htm,,,85427NY0020001-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$50 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,Solstice Health Insurance Company,85427,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,27-1395245,85427NY0010002,EssentialSmile 111 NS INN Family Dental Dep 29,85427NY001,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,http://www.solsticebenefits.com/paymybillcc/index.htm,,,85427NY0010002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$50 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,Solstice Health Insurance Company,85427,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),Yes,27-1395245,85427NY0020002,EssentialSmile 112 NS INN Family Dental Dep 29,85427NY002,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,http://www.solsticebenefits.com/paymybillcc/index.htm,,,85427NY0020002-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$50 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010505,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP29,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010505-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010506,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010506-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010509,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP25,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010509-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010511,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010511-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010485,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP25,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010485-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010487,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010487-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010489,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP29,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010489-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010490,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010490-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010501,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP25,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010501-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010503,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010503-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010513,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP29,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010513-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010514,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010514-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010597,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP25,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010597-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010599,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010599-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010601,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP29,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010601-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,22-2795650,85629NY0010602,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010602-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010486,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010486-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010488,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010488-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010491,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010491-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010492,MTRO GT 35/50/1500/70/EPO HSA 19 Silver NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF006,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010492-01,Standard Silver On Exchange Plan,71.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,500 ",$3000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,500 ",$200 ,"$2,700 ",$60 ,"$1,500 ","$1,400 ",$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010502,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010502-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010504,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010504-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010507,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010507-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010508,MTRO GT 5500/70/EPO HSA 19 Bronze NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010508-01,Standard Bronze On Exchange Plan,61.93%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$0 ,"$1,200 ",$60 ,"$5,500 ",$400 ,$40 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010510,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010510-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010512,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010512-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010515,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010515-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010516,MTRO GT 40/75/5750/50/EPO HSA 19 Bronze NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF003,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010516-01,Standard Bronze On Exchange Plan,61.60%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,750 ",$11500 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,700 ",$0 ,"$1,000 ",$60 ,"$5,700 ",$400 ,$10 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010598,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010598-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010600,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010600-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010603,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010603-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,22-2795650,85629NY0010604,MTRO GT 6550/100/EPO HSA 19 Bronze NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF007,Existing,EPO,Bronze,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010604-01,Standard Bronze On Exchange Plan,61.70%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,700 ",$13400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,500 ",$0 ,$0 ,$60 ,"$6,500 ",$0 ,$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010565,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP25,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010565-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010567,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010567-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010569,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP29,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010569-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010570,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010570-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010573,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP25,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010573-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010575,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010575-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010577,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP29,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010577-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,22-2795650,85629NY0010578,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010578-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010566,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010566-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010568,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010568-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010571,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010571-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010572,MTRO NG 30/80/3000/70/EPO ME 19 Silver NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010572-01,Standard Silver On Exchange Plan,71.95%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010574,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010574-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010576,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010576-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010579,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010579-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,22-2795650,85629NY0010580,MTRO NG 25/40/1250/80/EPO 19 Gold NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010580-01,Standard Gold On Exchange Plan,79.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010469,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP25,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010469-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010471,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010471-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010473,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP29,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010473-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010474,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010474-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010493,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP25,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010493-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010495,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010495-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010497,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP29,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010497-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,22-2795650,85629NY0010498,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010498-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010470,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010470-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010472,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010472-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010475,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010475-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010476,MTRO GT 25/40/1250/80/EPO 19 Gold NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Gold,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010476-01,Standard Gold On Exchange Plan,78.80%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,250 ",$2500 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,200 ",$300 ,"$1,900 ",$60 ,$400 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010494,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010494-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010496,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010496-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010499,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010499-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,22-2795650,85629NY0010500,MTRO GT 30/80/3000/70/EPO 19 Silver NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010500-01,Standard Silver On Exchange Plan,71.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ",$30 ,"$2,500 ",$60 ,$400 ,"$1,700 ",$0 ,$30 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2360001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep29",88582NY236,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2360001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2370001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep25, DP",88582NY237,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2370001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,22-2795650,85629NY0010453,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP25,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010453-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,22-2795650,85629NY0010455,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010455-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,22-2795650,85629NY0010457,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP29,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010457-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,22-2795650,85629NY0010458,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010458-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,22-2795650,85629NY0010454,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010454-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,22-2795650,85629NY0010456,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010456-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,22-2795650,85629NY0010459,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010459-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,22-2795650,85629NY0010460,MTRO GT 15/30/100/EPO 19 Platinum NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF011,Existing,EPO,Platinum,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010460-01,Standard Platinum On Exchange Plan,88.20%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$500 ,$0 ,$60 ,$100 ,"$1,600 ",$0 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,22-2795650,85629NY0010477,MTRO GT 15/70/3000/70 EPO PA 19 Silver NS INN DEP25,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010477-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,22-2795650,85629NY0010479,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP25 DP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010479-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,22-2795650,85629NY0010481,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP29,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010481-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,21,SHOP (Small Group),No,22-2795650,85629NY0010482,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP29 DP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010482-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,22,SHOP (Small Group),No,22-2795650,85629NY0010478,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP25 FP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010478-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,22,SHOP (Small Group),No,22-2795650,85629NY0010480,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP25 DP FP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010480-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,22,SHOP (Small Group),No,22-2795650,85629NY0010483,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP29 FP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010483-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,"Oxford Health Insurance, Inc.",85629,SBE-PUF,1,3/4/2019 0:00,22,SHOP (Small Group),No,22-2795650,85629NY0010484,MTRO GT 15/70/3000/70/EPO PA 19 Silver NS INN DEP29 DP FP,85629NY001,,NYN003,NYS003,NYF008,Existing,EPO,Silver,Yes,Both,No,Yes,"All, except OBGYN and as state mandated",,,,,Allows Adult and Child-Only,,No,"Heart Disease, Diabetes, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,,,https://www.oxfordhealth.com/shopny,85629NY0010484-01,Standard Silver On Exchange Plan,69.25%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$800 ,$60 ,$60 ,"$3,000 ",$800 ,$30 ,$30 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0140001,"EmblemHealth Platinum, Platinum, ST, INN, Pediatric Dental, Dep25",88582NY014,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0140001-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0140001,"EmblemHealth Platinum, Platinum, ST, INN, Pediatric Dental, Dep25",88582NY014,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0140001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0140001,"EmblemHealth Platinum, Platinum, ST, INN, Pediatric Dental, Dep25",88582NY014,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0140001-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0150001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep25",88582NY015,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0150001-01,Standard Gold On Exchange Plan,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0150001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep25",88582NY015,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0150001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0150001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep25",88582NY015,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0150001-03,Limited Cost Sharing Plan Variation,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-01,Standard Silver On Exchange Plan,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-03,Limited Cost Sharing Plan Variation,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,140 ",$0 ,$60 ,"$1,350 ","$1,585 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0160001,"EmblemHealth Silver, Silver, ST, INN, Pediatric Dental, Dep25",88582NY016,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0160001-06,94% AV Level Silver Plan,93.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$324 ,$0 ,$60 ,$0 ,$661 ,$86 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0170001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep25",88582NY017,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0170001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0170001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep25",88582NY017,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0170001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0170001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep25",88582NY017,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0170001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0180001,"EmblemHealth Basic, Catastrophic, ST, INN, Pediatric Dental",88582NY018,,NYN001,NYS001,NYF005,Existing,HMO,Catastrophic,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient Mental Health and Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0180001-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,890 ",$0 ,$10 ,$60 ,"$7,177 ",$0 ,$7 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0200001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep29",88582NY020,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0200001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0200001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep29",88582NY020,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0200001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0200001,"EmblemHealth Bronze, Bronze, ST, INN, Pediatric Dental, Dep29",88582NY020,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0200001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0210001,"EmblemHealth Bronze, Child Only, ST, INN, Pediatric Dental",88582NY021,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0210001-01,Standard Bronze On Exchange Plan,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0210001,"EmblemHealth Bronze, Child Only, ST, INN, Pediatric Dental",88582NY021,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0210001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0210001,"EmblemHealth Bronze, Child Only, ST, INN, Pediatric Dental",88582NY021,,NYN001,NYS001,NYF002,Existing,HMO,Bronze,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0210001-03,Limited Cost Sharing Plan Variation,61.99%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,597 ",$0 ,"$5,003 ",$60 ,"$3,592 ",$0 ,"$3,592 ",$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-01,Standard Silver On Exchange Plan,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-03,Limited Cost Sharing Plan Variation,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,140 ",$0 ,$60 ,"$1,350 ","$1,585 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0230001,"EmblemHealth Silver, Silver, ST, INN, Pediatic Dental Dep29",88582NY023,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0230001-06,94% AV Level Silver Plan,93.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$324 ,$0 ,$60 ,$0 ,$661 ,$86 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-01,Standard Silver On Exchange Plan,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-03,Limited Cost Sharing Plan Variation,71.23%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ","$2,140 ",$0 ,$60 ,"$1,700 ","$1,585 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-04,73% AV Level Silver Plan,73.68%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,140 ",$0 ,$60 ,"$1,350 ","$1,585 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-05,87% AV Level Silver Plan,86.86%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$250 ,$500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$946 ,$0 ,$60 ,$250 ,"$1,289 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0240001,"EmblemHealth Silver, Child Only, ST, INN, Pediatric Dental",88582NY024,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0240001-06,94% AV Level Silver Plan,93.69%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$324 ,$0 ,$60 ,$0 ,$881 ,$86 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0260001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep29",88582NY026,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0260001-01,Standard Gold On Exchange Plan,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0260001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep29",88582NY026,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0260001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0260001,"EmblemHealth Gold, Gold, ST, INN, Pediatric Dental, Dep29",88582NY026,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0260001-03,Limited Cost Sharing Plan Variation,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0270001,"EmblemHealth Gold, Child Only, ST, INN, Pediatric Dental",88582NY027,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0270001-01,Standard Gold On Exchange Plan,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0270001,"EmblemHealth Gold, Child Only, ST, INN, Pediatric Dental",88582NY027,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0270001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0270001,"EmblemHealth Gold, Child Only, ST, INN, Pediatric Dental",88582NY027,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0270001-03,Limited Cost Sharing Plan Variation,79.80%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$600 ,$1200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,"$1,540 ",$0 ,$60 ,$600 ,"$1,445 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0290001,"EmblemHealth Platinum, Platinum ST, INN, Pediatric Dental, Dep29",88582NY029,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0290001-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0290001,"EmblemHealth Platinum, Platinum ST, INN, Pediatric Dental, Dep29",88582NY029,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0290001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0290001,"EmblemHealth Platinum, Platinum ST, INN, Pediatric Dental, Dep29",88582NY029,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0290001-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0300001,"EmblemHealth Platinum, Child Only, ST, INN, Pediatric Dental",88582NY030,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0300001-01,Standard Platinum On Exchange Plan,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0300001,"EmblemHealth Platinum, Child Only, ST, INN, Pediatric Dental",88582NY030,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0300001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-1828429,88582NY0300001,"EmblemHealth Platinum, Child Only, ST, INN, Pediatric Dental",88582NY030,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0300001-03,Limited Cost Sharing Plan Variation,88.01%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,"$2,000 ",$0 ,$60 ,$0 ,"$1,300 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2350001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep25",88582NY235,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2350001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2380001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep29, DP",88582NY238,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2380001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2390001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep25, FP",88582NY239,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2390001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2400001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep29, FP",88582NY240,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2400001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2410001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY241,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2410001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2420001,"EmblemHealth Platinum Choice, Platinum, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY242,,NYN001,NYS001,NYF002,New,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2420001-01,Standard Platinum On Exchange Plan,86.66%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$880 ,$0 ,$60 ,$200 ,"$1,285 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2430001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY243,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2430001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2810001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY281,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2810001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2820001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY282,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2820001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2440001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY244,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2440001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2450001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep25, DP",88582NY245,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2450001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2460001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep29, DP",88582NY246,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2460001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2470001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep25, FP",88582NY247,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2470001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2480001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep29, FP",88582NY248,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2480001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2490001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY249,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2490001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2500001,"EmblemHealth Gold Choice, Gold, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY250,,NYN001,NYS001,NYF008,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2500001-01,Standard Gold On Exchange Plan,77.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$750 ,$1500 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,"$3,040 ",$0 ,$60 ,$750 ,"$2,345 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2510001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY251,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2510001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2520001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY252,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2520001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2530001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep25, DP",88582NY253,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2530001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2540001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep29, DP",88582NY254,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2540001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2550001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep25, FP",88582NY255,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2550001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2560001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep29, FP",88582NY256,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2560001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,13-1828429,88582NY2570001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY257,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2570001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1820001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep25",88582NY182,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1820001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1830001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep29",88582NY183,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1830001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1840001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep25, FP",88582NY184,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1840001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1850001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep25, DP",88582NY185,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1850001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1860001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY186,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1860001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1870001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep29, FP",88582NY187,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1870001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1880001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep29, DP",88582NY188,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1880001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY1890001,"EmblemHealth Platinum Premier, Platinum, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY189,,NYN002,NYS002,NYF007,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1890001-01,Standard Platinum On Exchange Plan,87.60%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,$0 ,$0 per group,,,,,,,,,,,$0 ,"$1,220 ",$0 ,$60 ,$0 ,"$1,605 ",$173 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-03,Limited Cost Sharing Plan Variation,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-04,73% AV Level Silver Plan,72.78%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,500 ",$0 ,$60 ,"$1,296 ","$1,905 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-05,87% AV Level Silver Plan,86.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$960 ,$0 ,$60 ,$250 ,"$1,289 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1900001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep25, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY190,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1900001-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$520 ,$0 ,$60 ,$0 ,$936 ,$64 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-03,Limited Cost Sharing Plan Variation,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-04,73% AV Level Silver Plan,72.78%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,500 ",$0 ,$60 ,"$1,296 ","$1,905 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-05,87% AV Level Silver Plan,86.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$960 ,$0 ,$60 ,$250 ,"$1,289 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1910001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental, Dep29, Family Vision, Free PCP Visits, No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY191,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1910001-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$520 ,$0 ,$60 ,$0 ,$936 ,$64 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-01,Standard Silver On Exchange Plan,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-03,Limited Cost Sharing Plan Variation,68.90%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,100 ",$12200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,505 ",$595 ,$0 ,$60 ,"$4,848 ","$1,250 ",$2 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-04,73% AV Level Silver Plan,72.78%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,100 ",$10200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ","$2,500 ",$0 ,$60 ,"$1,296 ","$1,905 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-05,87% AV Level Silver Plan,86.09%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,700 ",$3400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$960 ,$0 ,$60 ,$250 ,"$1,289 ",$432 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY1920001,"EmblemHealth Silver Value, Child Only, NS, INN, Pediatric Dental, Pediatric Vision, Free PCP Visits,No Deductible Generic Drugs and Specialist Visits, Free Telemedicine, Acupuncture",88582NY192,,NYN001,NYS001,NYF006,Existing,HMO,Silver,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY1920001-06,94% AV Level Silver Plan,93.10%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$700 ,$1400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$520 ,$0 ,$60 ,$0 ,$936 ,$64 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2020001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep25",88582NY202,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2020001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2030001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep29",88582NY203,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2030001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2040001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep25, DP",88582NY204,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2040001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2050001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep29, DP",88582NY205,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2050001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2060001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep25, FP",88582NY206,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2060001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2070001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep29, FP",88582NY207,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2070001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2080001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY208,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2080001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2090001,"EmblemHealth Bronze Value, Bronze, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY209,,NYN001,NYS001,NYF001,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2090001-01,Standard Bronze On Exchange Plan,60.76%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,690 ",$15380 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$340 ,$0 ,$60 ,"$6,374 ","$1,250 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2580001,"EmblemHealth Gold Value, Gold, NS, INN, Family Dental & Vision, Dep29, DP,FP",88582NY258,,NYN001,NYS001,NYF011,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2580001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,765 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2750001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY275,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2750001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2760001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY276,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2760001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2770001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY277,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2770001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2780001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY278,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2780001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2790001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY279,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2790001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,13-1828429,88582NY2800001,"EmblemHealth Silver Choice, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY280,,NYN001,NYS001,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2800001-01,Standard Silver On Exchange Plan,69.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,100 ",$14200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,800 ","$3,020 ",$0 ,$60 ,"$2,800 ","$2,060 ",$528 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3310001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 25, Family Dental and Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY331,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3310001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3310001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 25, Family Dental and Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY331,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3310001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2600001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY260,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2600001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2610001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY261,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2610001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2620001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY262,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2620001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2630001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY263,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2630001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2640001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY264,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2640001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2650001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY265,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2650001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2660001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY266,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2660001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3310001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 25, Family Dental and Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY331,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3310001-03,Limited Cost Sharing Plan Variation,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3320001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 29, Family Dental, Family Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY332,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3320001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3320001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 29, Family Dental, Family Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY332,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3320001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3320001,"EmblemHealth Gold Value, Gold, NS, INN, Dep 29, Family Dental, Family Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY332,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3320001-03,Limited Cost Sharing Plan Variation,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3330001,"EmblemHealth Gold Value, Gold, NS, INN, Child-Only, Pediatric Dental, Pediatric Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY333,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3330001-01,Standard Gold On Exchange Plan,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3330001,"EmblemHealth Gold Value, Gold, NS, INN, Child-Only, Pediatric Dental, Pediatric Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY333,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3330001-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-1828429,88582NY3330001,"EmblemHealth Gold Value, Gold, NS, INN, Child-Only, Pediatric Dental, Pediatric Vision, 3 Free PCP, No Deductible Generic Drugs, Specialist and Urgent Care, Free Telemedicine and Acupuncture",88582NY333,,NYN001,NYS001,NYF007,New,HMO,Gold,Yes,On the Exchange,No,Yes,"All Except: OB/GYN, Mammography screenings, Outpatient and Mental Health Substance Abuse, Optical and Dental Services, Chiropractic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,http://www.emblemhealth.com/firstpayment,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3330001-03,Limited Cost Sharing Plan Variation,78.45%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,895 ","$1,105 ",$0 ,$60 ,"$1,764 ","$1,235 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2100001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY210,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2100001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2110001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY211,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2110001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2120001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY212,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2120001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2130001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY213,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2130001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2140001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY214,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2140001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2150001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY215,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2150001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2160001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY216,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2160001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,13-1828429,88582NY2170001,"EmblemHealth Silver Value, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY217,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2170001-01,Standard Silver On Exchange Plan,69.17%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,300 ",$12600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,705 ",$595 ,$0 ,$60 ,"$5,030 ","$1,270 ",$0 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2590001,"EmblemHealth Silver Premier, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY259,,NYN002,NYS002,NYF009,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2590001-01,Standard Silver On Exchange Plan,71.98%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,300 ",$6600 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,300 ","$3,110 ",$0 ,$60 ,"$1,210 ","$2,150 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2670001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY267,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2670001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2680001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY268,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2680001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2690001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY269,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2690001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2700001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY270,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2700001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2710001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY271,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2710001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2720001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY272,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2720001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2730001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY273,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2730001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY2740001,"EmblemHealth Silver Plus, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY274,,NYN002,NYS002,NYF012,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2740001-01,Standard Silver On Exchange Plan,69.93%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,550 ",$5100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,550 ","$3,220 ",$0 ,$60 ,"$1,914 ","$2,460 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3070001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY307,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3070001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3150001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep25",88582NY315,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3150001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3160001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY316,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3160001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3170001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY317,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3170001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3180001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY318,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3180001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3190001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY319,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3190001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3200001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY320,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3200001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3210001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY321,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3210001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,13-1828429,88582NY3220001,"EmblemHealth Silver Plus 1, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY322,,NYN002,NYS002,NYF013,New,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3220001-01,Standard Silver On Exchange Plan,70.84%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,000 ",$14000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,843 ",$595 ,"$4,562 ",$60 ,"$1,064 ","$2,260 ",$864 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2830001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY283,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2830001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2840001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY284,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2840001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2850001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep25, DP",88582NY285,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2850001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2860001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep29, DP",88582NY286,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2860001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2870001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep25, FP",88582NY287,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2870001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2880001,"EmblemHealth Gold Premier 1 , Gold, NS, INN, Family Dental & Vision, Dep29, FP",88582NY288,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2880001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2890001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY289,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2890001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2900001,"EmblemHealth Gold Premier 1, Gold, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY290,,NYN002,NYS002,NYF010,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2900001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,800 ",$13600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ",$120 ,"$2,737 ",$60 ,"$1,310 ","$1,410 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2910001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY291,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2910001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2920001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY292,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2920001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2930001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep25, DP",88582NY293,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2930001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2940001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep29, DP",88582NY294,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2940001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2950001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep25, FP",88582NY295,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2950001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2960001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep29, FP",88582NY296,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2960001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2970001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY297,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2970001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY2980001,"EmblemHealth Gold Plus 1, Gold, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY298,,NYN002,NYS002,NYF009,New,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2980001-01,Standard Gold On Exchange Plan,80.15%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$680 ,$0 ,$60 ,"$1,100 ","$1,280 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3080001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep29",88582NY308,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3080001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3090001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep25, DP",88582NY309,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3090001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3100001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep29, DP",88582NY310,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3100001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3110001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep25, FP",88582NY311,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3110001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3120001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep29, FP",88582NY312,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3120001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3130001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY313,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3130001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,13-1828429,88582NY3140001,"EmblemHealth Silver Premier 1, Silver, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY314,,NYN002,NYS002,NYF008,New,HMO,Silver,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY3140001-01,Standard Silver On Exchange Plan,71.97%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,300 ",$14600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,700 ",$5400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,700 ",$840 ,"$2,737 ",$60 ,"$1,410 ","$2,305 ",$518 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0430001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY043,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0430001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0440001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY044,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0440001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0530001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep25, DP",88582NY053,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0530001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0540001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep29, DP",88582NY054,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0540001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0820001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep25, FP",88582NY082,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0820001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0830001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep29, FP",88582NY083,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0830001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0840001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep25, DP, FP",88582NY084,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0840001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY0850001,"EmblemHealth Gold Plus, Gold, NS, INN, Family Dental & Vision, Dep29, DP, FP",88582NY085,,NYN002,NYS002,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY0850001-01,Standard Gold On Exchange Plan,79.70%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$550 ,$1100 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$550 ,"$2,380 ",$0 ,$60 ,$550 ,"$1,935 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2260001,"EmblemHealth Gold Premier, Gold, NS, INN, Family Dental & Vision, Dep25",88582NY226,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2260001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2270001,"EmblemHealth Gold Premier, Gold, NS, INN, Family Dental & Vision, Dep29",88582NY227,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2270001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2280001,"EmblemHealth Gold Premier, Gold, NS, INN, DP, Family Dental & Vision, Dep25",88582NY228,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2280001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2290001,"EmblemHealth Gold Premier, Gold, NS, INN, DP, Family Dental & Vision, Dep29",88582NY229,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2290001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2300001,"EmblemHealth Gold Premier, Gold, NS, INN, FP, Family Dental & Vision, Dep25",88582NY230,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2300001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2310001,"EmblemHealth Gold Premier, Gold, NS, INN, FP, Family Dental & Vision, Dep29",88582NY231,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2310001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2320001,"EmblemHealth Gold Premier, Gold, NS, INN, DP, FP, Family Dental & Vision, Dep25",88582NY232,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2320001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,13-1828429,88582NY2330001,"EmblemHealth Gold Premier, Gold, NS, INN, DP, FP,  Family Dental & Vision, Dep29",88582NY233,,NYN002,NYS002,NYF006,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2330001-01,Standard Gold On Exchange Plan,81.41%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$450 ,$900 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$450 ,"$1,660 ",$0 ,$60 ,$450 ,"$1,520 ",$346 ,$55 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010225,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010225-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010226,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010226-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010233,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010233-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2180001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep25, Pediatric Vision",88582NY218,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2180001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2190001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep29, Pediatric Vision",88582NY219,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2190001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2200001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep25, Pediatric Vision, DP",88582NY220,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2200001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2210001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep29, Pediatric Vision, DP",88582NY221,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2210001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2220001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep25, Pediatric Vision, FP",88582NY222,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2220001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2230001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep29, Pediatric Vision, FP",88582NY223,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2230001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2240001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep25, Pediatric Vision, DP, FP",88582NY224,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2240001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,Health Insurance Plan of Greater New York,88582,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,13-1828429,88582NY2250001,"EmblemHealth Bronze Plus H.S.A., Bronze, ST, INN, Pediatric Dental, Dep29, Pediatric Vision, DP, FP",88582NY225,,NYN002,NYS001,NYF004,Existing,HMO,Bronze,Yes,Both,No,Yes,"All Except: OB/GYN, Mammography Screening, Outpatient Mental Health and Substance Abuse, Optical and Dental Service, Chiropratic Care",,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.emblemhealth.com/Contact-Us/Sales,,http://www.emblemhealth.com/Pharmacy/See-Covered-Drugs,88582NY2250001-01,Standard Bronze On Exchange Plan,60.87%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,110 ",$40 ,"$5,100 ",$60 ,"$4,100 ",$770 ,$600 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010001,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010001-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010002,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010002-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010003,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010003-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010005,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010005-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010070,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010070-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010071,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010071-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010072,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010072-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010074,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010074-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010217,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010217-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010218,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010218-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010234,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010234-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010249,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010249-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,23-3197320,89846NY0010250,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010250-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010008,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010008-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010009,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010009-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010108,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010108-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010110,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010110-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010221,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010221-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010010,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010010-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010012,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010012-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010079,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010079-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010080,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010080-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010081,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010081-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010083,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010083-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010219,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010219-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010220,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010220-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010227,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010227-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010228,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010228-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010235,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010235-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010236,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010236-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010251,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010251-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,23-3197320,89846NY0010252,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010252-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010035,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010035-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010036,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010036-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010037,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010037-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010039,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010039-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010106,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010106-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010107,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010107-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010222,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010222-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010229,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010229-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010230,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010230-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010237,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010237-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010238,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010238-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010253,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010253-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,23-3197320,89846NY0010254,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010254-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010042,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010042-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010043,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010043-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010015,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010015-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010019,"MVP EPO Silver 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010019-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$2,221 ",$0 ,$60 ,$300 ,"$1,289 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$929 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020024,"Healthfirst Gold Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020024-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020024,"Healthfirst Gold Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020024-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020024,"Healthfirst Gold Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020024-03,Limited Cost Sharing Plan Variation,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020026,"Healthfirst Platinum Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020026-01,Standard Platinum On Exchange Plan,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020026,"Healthfirst Platinum Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020026-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020026,"Healthfirst Platinum Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020026-03,Limited Cost Sharing Plan Variation,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010044,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010044-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010046,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010046-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010115,"MVP EPO HDHP Bronze 3, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010115-01,Standard Bronze On Exchange Plan,,0.61887198,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,900 ",$11800 per group,30.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,900 ",$0 ,$700 ,$70 ,"$5,900 ",$400 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010116,"MVP EPO HDHP Silver 3, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010116-01,Standard Silver On Exchange Plan,,0.714429378,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$600 ,$0 ,$70 ,"$2,200 ","$1,200 ",$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010117,"MVP EPO HDHP Gold 2, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF009,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010117-01,Standard Gold On Exchange Plan,,0.772534416,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,500 ",$9000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,600 ",$3200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,600 ",$300 ,$0 ,$60 ,"$1,600 ",$700 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010119,"MVP EPO HDHP Bronze 5, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010119-01,Standard Bronze On Exchange Plan,,0.623005394,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,350 ",$10700 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,350 ",$0 ,"$1,200 ",$60 ,"$5,350 ",$200 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010223,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010223-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010224,"MVP EPO HDHP Silver 8, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010224-01,Standard Silver On Exchange Plan,,0.706728822,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$10 ,$0 ,$70 ,"$3,700 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010231,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010231-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010232,"MVP EPO HDHP Bronze 6, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telelmedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF008,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010232-01,Standard Bronze On Exchange Plan,,0.617118557,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,550 ",$0 ,$0 ,$60 ,"$6,550 ",$0 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010239,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010239-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010240,"MVP EPO HDHP Bronze 7, Expanded Bronze, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010240-01,Standard Bronze On Exchange Plan,,0.628733476,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,40.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,800 ",$0 ,"$1,800 ",$70 ,"$4,800 ",$0 ,"$1,100 ",$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010255,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DPá",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010255-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,23-3197320,89846NY0010256,"MVP EPO HDHP Gold 7, HSA, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Preventive Drugs,Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF010,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010256-01,Standard Gold On Exchange Plan,,0.814321498,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,700 ",$5400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,350 ",$2700 per group,15.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$0 ,"$1,400 ",$60 ,"$1,350 ",$0 ,$900 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010021,"MVP EPO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010021-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010023,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010023-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010087,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010087-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010091,"MVP EPO Silver 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010091-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010093,"MVP EPO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010093-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,23-3197320,89846NY0010095,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010095-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010016,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010016-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010020,"MVP EPO Silver 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010020-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010022,"MVP EPO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010022-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010025,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010025-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010088,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010088-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010092,"MVP EPO Silver 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010092-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010094,"MVP EPO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010094-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,23-3197320,89846NY0010167,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010167-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010049,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010049-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010053,"MVP EPO Silver 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010053-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010055,"MVP EPO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010055-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010057,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010057-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010123,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010123-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010127,"MVP EPO Silver 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010127-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010129,"MVP EPO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010129-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,7,SHOP (Small Group),No,23-3197320,89846NY0010131,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP, FP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010131-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010050,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010050-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010054,"MVP EPO Silver 2, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010054-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010056,"MVP EPO Gold 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010056-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010059,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010059-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010124,"MVP EPO Bronze 2, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF012,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010124-01,Standard Bronze On Exchange Plan,,0.643736647,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,000 ",$50 ,"$1,700 ",$70 ,"$5,000 ",$600 ,$0 ,$500 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010128,"MVP EPO Silver 2, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF013,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010128-01,Standard Silver On Exchange Plan,,0.662557896,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,700 ",$7400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,700 ",$100 ,"$1,100 ",$100 ,$400 ,"$1,700 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010130,"MVP EPO Gold 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF006,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010130-01,Standard Gold On Exchange Plan,,0.775396081,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$850 ,$1700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$850 ,$700 ,$0 ,$60 ,$400 ,"$1,100 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,8,SHOP (Small Group),No,23-3197320,89846NY0010133,"MVP EPO Platinum 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, 3PCP, DP",89846NY001,,NYN001,NYS001,NYF005,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010133-01,Standard Platinum On Exchange Plan,,0.869168955,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,450 ",$4900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$400 ,$0 ,$60 ,$0 ,$700 ,$0 ,$60 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010017,"MVP EPO Silver 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010017-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010031,"MVP EPO Gold 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010031-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010089,"MVP EPO Silver 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010089-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010101,"MVP EPO Gold 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010101-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010151,"MVP EPO Gold 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010151-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010152,"MVP EPO Gold 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010152-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010177,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010177-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010178,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010178-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010193,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010193-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010194,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010194-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010201,"MVP EPO Gold 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010201-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010202,"MVP EPO Gold 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010202-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010209,"MVP EPO Silver 7, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010209-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010210,"MVP EPO Silver 7, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010210-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010257,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010257-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010258,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010258-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010265,"MVP EPO Gold 8, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010265-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,9,SHOP (Small Group),No,23-3197320,89846NY0010266,"MVP EPO Gold 8, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010266-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010018,"MVP EPO Silver 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010018-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010032,"MVP EPO Gold 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010032-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010090,"MVP EPO Silver 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010090-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010102,"MVP EPO Gold 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010102-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010153,"MVP EPO Gold 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010153-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010154,"MVP EPO Gold 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010154-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010179,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010179-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010180,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010180-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010195,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010195-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010196,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010196-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010203,"MVP EPO Gold 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010203-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010204,"MVP EPO Gold 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010204-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010211,"MVP EPO Silver 7, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010211-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010212,"MVP EPO Silver 7, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010212-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010259,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010259-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010260,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010260-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010267,"MVP EPO Gold 8, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010267-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,10,SHOP (Small Group),No,23-3197320,89846NY0010268,"MVP EPO Gold 8, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010268-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010051,"MVP EPO Silver 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010051-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010065,"MVP EPO Gold 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010065-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010125,"MVP EPO Silver 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010125-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010139,"MVP EPO Gold 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010139-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010155,"MVP EPO Gold 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010155-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010156,"MVP EPO Gold 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010156-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010181,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010181-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010182,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010182-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010197,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010197-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010198,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010198-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010205,"MVP EPO Gold 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010205-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010206,"MVP EPO Gold 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010206-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010213,"MVP EPO Silver 7, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010213-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010214,"MVP EPO Silver 7, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010214-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010261,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010261-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010262,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010262-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010269,"MVP EPO Gold 8, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010269-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,11,SHOP (Small Group),No,23-3197320,89846NY0010270,"MVP EPO Gold 8, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FPá",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010270-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010052,"MVP EPO Silver 1, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010052-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010066,"MVP EPO Gold 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010066-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010126,"MVP EPO Silver 1, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF007,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010126-01,Standard Silver On Exchange Plan,,0.718843157,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,100 ",$4200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$100 ,$200 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,100 ",$100 ,"$1,500 ",$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010140,"MVP EPO Gold 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010140-01,Standard Gold On Exchange Plan,,0.787298147,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,400 ",$8800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$800 ,$1600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$800 ,$900 ,$0 ,$70 ,$800 ,$900 ,$0 ,$200 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010157,"MVP EPO Gold 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010157-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010158,"MVP EPO Gold 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010158-01,Standard Gold On Exchange Plan,,0.788611646,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,750 ",$13500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$900 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010183,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010183-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010184,"MVP EPO Platinum 3, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF004,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010184-01,Standard Platinum On Exchange Plan,,0.868587757,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,800 ",$5600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$300 ,$0 ,$90 ,$0 ,"$1,800 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010199,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010199-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010200,"MVP EPO Platinum 5, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Platinum,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010200-01,Standard Platinum On Exchange Plan,,0.867770728,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$3,550 ",$7100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$600 ,$0 ,$70 ,$0 ,"$1,200 ",$0 ,$300 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010207,"MVP EPO Gold 6, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010207-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010208,"MVP EPO Gold 6, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010208-01,Standard Gold On Exchange Plan,,0.784714399,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$350 ,$700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$350 ,"$1,200 ",$0 ,$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010215,"MVP EPO Silver 7, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010215-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010216,"MVP EPO Silver 7, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010216-01,Standard Silver On Exchange Plan,,0.719356878,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,700 ",$15400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,100 ",$6200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,100 ",$600 ,$0 ,$90 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010263,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010263-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010264,"MVP EPO Bronze 8, Expanded Bronze, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF003,New,EPO,Expanded Bronze,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010264-01,Standard Bronze On Exchange Plan,,0.634318095,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,350 ",$100 ,$0 ,$100 ,$400 ,"$1,700 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010271,"MVP EPO Gold 8, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010271-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,12,SHOP (Small Group),No,23-3197320,89846NY0010272,"MVP EPO Gold 8, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF002,New,EPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010272-01,Standard Gold On Exchange Plan,,0.760887107,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$8000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,20.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$4,000 ",$100 ,"$1,100 ",$90 ,$0 ,"$1,900 ",$0 ,$600 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,23-3197320,89846NY0010029,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010029-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,13,SHOP (Small Group),No,23-3197320,89846NY0010099,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010099-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,23-3197320,89846NY0010030,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010030-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,14,SHOP (Small Group),No,23-3197320,89846NY0010100,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010100-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,23-3197320,89846NY0010063,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010063-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,15,SHOP (Small Group),No,23-3197320,89846NY0010137,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010137-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,23-3197320,89846NY0010064,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010064-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,16,SHOP (Small Group),No,23-3197320,89846NY0010138,"MVP EPO HRA Silver 4, INN, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY001,,NYN001,NYS001,NYF001,New,EPO,Silver,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0010138-01,Standard Silver On Exchange Plan,,0.711451692,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,350 ",$12700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,500 ",$900 ,$0 ,$70 ,"$2,500 ",$900 ,$0 ,$400 
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,23-3197320,89846NY0020001,"MVP PPO Gold, OON, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FP",89846NY002,,NYN001,NYS001,NYF002,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020001-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,17,SHOP (Small Group),No,23-3197320,89846NY0020016,"MVP PPO Gold, OON, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP, FP",89846NY002,,NYN001,NYS001,NYF002,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020016-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,23-3197320,89846NY0020002,"MVP PPO Gold, OON, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020002-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,18,SHOP (Small Group),No,23-3197320,89846NY0020003,"MVP PPO Gold, OON, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Wellness, DP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020003-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,23-3197320,89846NY0020004,"MVP PPO Gold, OON, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020004-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,19,SHOP (Small Group),No,23-3197320,89846NY0020005,"MVP PPO Gold, OON, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP, FP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020005-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,23-3197320,89846NY0020006,"MVP PPO Gold, OON, Pediatric Dental, Dep29, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020006-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,MVP Health Services Corp.,89846,SBE-PUF,1,3/4/2019 0:00,20,SHOP (Small Group),No,23-3197320,89846NY0020007,"MVP PPO Gold, OON, Pediatric Dental, Dep25, Adult Vision, Acupuncture, Preferred Facility, Telemedicine, Unlimited SNF, Wellness, DP",89846NY002,,NYN001,NYS001,NYF001,New,PPO,Gold,No,Both,No,No,,,,,,Allows Adult-Only,,No,"Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,www.mvphealthcare.com/employers,,https://www.mvphealthcare.com/members/prescription-benefits/,89846NY0020007-01,Standard Gold On Exchange Plan,,0.774368304,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,"$8,000 ",$16000 per group,Not Applicable,per group not applicable,$700 ,$1400 per group,0.00%,,,,"$4,000 ",$8000 per group,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$700 ,$600 ,$0 ,$100 ,$0 ,"$1,900 ",$0 ,"$1,100 "
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020003,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020003-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020003,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020003-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020003,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020003-03,Limited Cost Sharing Plan Variation,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020004,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020004-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020004,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020004-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020004,"Healthfirst Bronze Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020020,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020004-03,Limited Cost Sharing Plan Variation,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-01,Standard Silver On Exchange Plan,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-03,Limited Cost Sharing Plan Variation,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,650 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$300 ,"$2,221 ",$0 ,$60 ,$300 ,"$1,289 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020007,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020007-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$929 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-01,Standard Silver On Exchange Plan,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-03,Limited Cost Sharing Plan Variation,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$300 ,"$2,221 ",$0 ,$60 ,$300 ,"$1,289 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020008,"Healthfirst Silver Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020022,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020008-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$929 ,$0 ,$60 ,$0 ,$821 ,$86 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020011,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020011-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020011,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020011-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020011,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020011-03,Limited Cost Sharing Plan Variation,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020012,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020012-01,Standard Gold On Exchange Plan,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020012,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020012-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020012,"Healthfirst Gold Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020024,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020012-03,Limited Cost Sharing Plan Variation,80.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$3,510 ",$0 ,$60 ,$600 ,"$1,685 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020015,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020015-01,Standard Platinum On Exchange Plan,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020015,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020015-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020015,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep25, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020015-03,Limited Cost Sharing Plan Variation,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020016,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020016-01,Standard Platinum On Exchange Plan,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020016,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020016-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020016,"Healthfirst Platinum Leaf, ST, INN, Pediatric Dental, Dep29, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,91237NY0020026,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020016-03,Limited Cost Sharing Plan Variation,90.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020018,"Healthfirst Green Leaf, Catastrophic, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF008,Existing,HMO,Catastrophic,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020018-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,100.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$7,900 ",$0 ,$0 ,$60 ,"$7,900 ",$0 ,$0 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020020,"Healthfirst Bronze Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020020-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020020,"Healthfirst Bronze Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020020-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020020,"Healthfirst Bronze Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF007,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020020-03,Limited Cost Sharing Plan Variation,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,600 ",$15200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-01,Standard Silver On Exchange Plan,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-03,Limited Cost Sharing Plan Variation,70.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,700 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,13-3783732,91237NY0020022,"Healthfirst Silver Leaf, Child-Only, ST, INN, Pediatric Dental, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020022-04,73% AV Level Silver Plan,73.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,350 ","$4,200 ",$0 ,$60 ,"$1,588 ","$1,905 ",$864 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020052,"Healthfirst Bronze Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020052-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020052,"Healthfirst Bronze Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020052-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020052,"Healthfirst Bronze Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020052-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020053,"Healthfirst Bronze Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020053-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020053,"Healthfirst Bronze Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020053-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020053,"Healthfirst Bronze Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF014,Existing,HMO,Bronze,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020053-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,50.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,000 ",$40 ,"$6,299 ",$60 ,"$4,000 ",$765 ,"$1,463 ",$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020058,"Healthfirst Platinum Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020058-01,Standard Platinum On Exchange Plan,88.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020058,"Healthfirst Platinum Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020058-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020058,"Healthfirst Platinum Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020058-03,Limited Cost Sharing Plan Variation,88.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020059,"Healthfirst Platinum Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020059-01,Standard Platinum On Exchange Plan,88.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020059,"Healthfirst Platinum Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020059-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,13-3783732,91237NY0020059,"Healthfirst Platinum Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF012,Existing,HMO,Platinum,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020059-03,Limited Cost Sharing Plan Variation,88.73%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$2,900 ",$0 ,$60 ,$0 ,"$1,450 ",$173 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ","$4,196 ",$0 ,$60 ,"$1,934 ","$1,939 ",$518 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ","$4,196 ",$0 ,$60 ,"$1,934 ","$1,939 ",$518 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800 ",$11600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,370 ",$4740 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,370 ","$4,196 ",$0 ,$60 ,"$2,020 ","$1,939 ",$432 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-05,87% AV Level Silver Plan,87.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020054,"Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020054-06,94% AV Level Silver Plan,94.50%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-01,Standard Silver On Exchange Plan,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ","$4,196 ",$0 ,$60 ,"$1,934 ","$1,939 ",$518 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-03,Limited Cost Sharing Plan Variation,71.99%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$3,000 ",$6000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$3,000 ","$4,196 ",$0 ,$60 ,"$1,934 ","$1,939 ",$518 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,800 ",$11600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,370 ",$4740 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,370 ","$4,196 ",$0 ,$60 ,"$2,020 ","$1,939 ",$432 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020055,"Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF010,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020055-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020056,"Healthfirst Gold Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020056-01,Standard Gold On Exchange Plan,79.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$900 ,$1800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$900 ,"$3,506 ",$0 ,$60 ,$900 ,"$1,719 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020056,"Healthfirst Gold Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020056-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020056,"Healthfirst Gold Leaf Premier, NS, INN, Dep25, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020056-03,Limited Cost Sharing Plan Variation,79.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$900 ,$1800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$900 ,"$3,506 ",$0 ,$60 ,$900 ,"$1,719 ",$346 ,$55 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380018,"EPO Copayment 220, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380018-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380020,"EPO Copayment 220, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380020-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380022,"EPO Copayment 220, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380022-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380097,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380097-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380200,"EPO Hybrid 222, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380200-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380788,"EPO Copayment 121, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380788-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380790,"EPO Copayment 121, Platinum, NS, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380790-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020057,"Healthfirst Gold Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020057-01,Standard Gold On Exchange Plan,79.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$900 ,$1800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$900 ,"$3,506 ",$0 ,$60 ,$900 ,"$1,719 ",$346 ,$55 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020057,"Healthfirst Gold Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020057-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,"Healthfirst PHSP, Inc.",91237,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,13-3783732,91237NY0020057,"Healthfirst Gold Leaf Premier, NS, INN, Dep29, Family Dental, Family Vision, No Deductible PCP Visits , Free Telemedicine, Fitness & Wellness Rewards",91237NY002,,NYN001,NYS001,NYF011,Existing,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult and Child-Only,,No,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.hfbillpay.org,,http://healthfirst.org/formulary/,91237NY0020057-03,Limited Cost Sharing Plan Variation,79.61%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,000 ",$10000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$900 ,$1800 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$900 ,"$3,506 ",$0 ,$60 ,$900 ,"$1,719 ",$346 ,$55 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380001,"EPO Copayment 120, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380001-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380002,"EPO Copayment 120 ,Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380002-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380004,"EPO Copayment 120, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380004-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380006,"EPO Copayment 120, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380006-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380017,"EPO Copayment 220, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380017-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380098,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380098-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380100,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380100-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380102,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380102-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380193,"EPO Hybrid 222, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380193-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380194,"EPO Hybrid 222, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380194-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380196,"EPO Hybrid 222, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380196-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380198,"EPO Hybrid 222, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380198-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380786,"EPO Copayment 121, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380786-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380787,"EPO Copayment 121, Platinum, NS,  INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380787-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380789,"EPO Copayment 121, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380789-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380791,"EPO Copayment 121, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380791-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380810,"EPO Copayment 130, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380810-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380811,"EPO Copayment 130, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380811-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380813,"EPO Copayment 130, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380813-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),No,16-1520935,92551NY0380815,"EPO Copayment 130, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380815-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380003,"EPO Copayment 120, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380003-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380005,"EPO Copayment 120 ,Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380005-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380007,"EPO Copayment 120, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380007-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380008,"EPO Copayment 120, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380008-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380019,"EPO Copayment 220, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380019-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380021,"EPO Copayment 220, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380021-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380023,"EPO Copayment 220, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380023-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380024,"EPO Copayment 220, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380024-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$500 ,$1000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$500 ,"$1,116 ",$0 ,$0 ,$0 ,"$1,555 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380099,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380099-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380101,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK,",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380101-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380103,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380103-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380104,"Embrace Health EPO Copayment 221, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380104-01,Standard Gold On Exchange Plan,77.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$250 ,"$1,433 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380195,"EPO Hybrid 222, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380195-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380197,"EPO Hybrid 222, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380197-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380199,"EPO Hybrid 222, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380199-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,250 ",$12500 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,$433 ,"$1,711 ",$0 ,$0 ,"$1,429 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380792,"EPO Copayment 121, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380792-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380793,"EPO Copayment 121, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380793-01,Standard Platinum On Exchange Plan,89.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,"$1,066 ",$0 ,$0 ,$0 ,"$1,267 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380812,"EPO Copayment 130, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK,",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380812-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380814,"EPO Copayment 130, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK,",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380814-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380816,"EPO Copayment 130, Platinum, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380816-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),No,16-1520935,92551NY0380817,"EPO Copayment 130, Platinum, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF001,Existing,EPO,Platinum,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380817-01,Standard Platinum On Exchange Plan,86.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$0 ,$816 ,$0 ,$0 ,$0 ,"$1,096 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380824,"EPO Copayment 230, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380824-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380825,"EPO Copayment 230, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380825-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380385,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380385-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380386,"HDEPO Qualified 320, Silver, HSA,  NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380386-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380388,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380388-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380390,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380390-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380818,"EPO Copayment 230, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380818-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380819,"EPO Copayment 230, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380819-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380821,"EPO Copayment 230, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380821-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380823,"EPO Copayment 230, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380823-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380834,"EPO Copayment 330, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380834-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380835,"EPO Copayment 330, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380835-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380837,"EPO Copayment 330, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380837-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380839,"EPO Copayment 330, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380839-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380866,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380866-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380867,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK,  FP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380867-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380869,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380869-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,16-1520935,92551NY0380871,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380871-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380387,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380387-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380389,"HDEPO Qualified 320, Silver, HSA,  NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380389-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380391,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380391-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380392,"HDEPO Qualified 320, Silver, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380392-01,Standard Silver On Exchange Plan,71.07%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$863 ,$0 ,$0 ,"$1,750 ","$1,277 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380820,"EPO Copayment 230, Gold, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380820-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380822,"EPO Copayment 230, Gold, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380822-01,Standard Gold On Exchange Plan,78.48%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,$600 ,"$1,382 ",$0 ,$0 ,$0 ,"$1,657 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380836,"EPO Copayment 330, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380836-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380838,"EPO Copayment 330, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380838-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380840,"EPO Copayment 330, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380840-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380841,"EPO Copayment 330, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380841-01,Standard Silver On Exchange Plan,70.68%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,000 ",$4000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,000 ","$1,883 ",$0 ,$0 ,$0 ,"$1,882 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380868,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380868-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380870,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380870-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380872,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380872-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,16-1520935,92551NY0380873,"HDEPO EPC Non-Qualified 328, Silver, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF004,New,EPO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380873-01,Standard Silver On Exchange Plan,68.11%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,200 ",$14400 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$83 ,"$1,321 ",$0 ,"$2,500 ","$1,394 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380433,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380433-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380434,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380434-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380436,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380436-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380438,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380438-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380802,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380802-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380803,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380803-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380805,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380805-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380439,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380439-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380807,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380807-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380842,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380842-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380843,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380843-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380845,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380845-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380847,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380847-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380850,"EPO Copay First 425, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380850-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380851,"EPO Copay First 425, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380851-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380853,"EPO Copay First 425, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380853-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380855,"EPO Copay First 425, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380855-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380858,"HDEPO Qualified 430,Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380858-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380859,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380859-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380861,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380861-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,5,SHOP (Small Group),No,16-1520935,92551NY0380863,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP, FP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380863-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380435,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380435-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380437,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380437-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380440,"HDEPO Qualified 421, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF006,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380440-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,"$3,377 ",$0 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380804,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380804-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380806,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380806-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380808,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380808-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260086,"HDHMO Qualified 324, Silver, HSA,  NS, INN, Dep29, Adult Vision, Wellness, LASIK,Dep25, DP, FP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260086-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260089,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK,Dep25, FP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260089-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260090,"HDHMO Smart Deductible 223, Gold HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK,Dep25, FP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260090-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260092,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK,Dep25, DP, FP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260092-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380809,"HDEPO Non-Qualified 423, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF007,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380809-01,Standard Bronze On Exchange Plan,60.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,150 ",$14300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$82 ,"$1,567 ",$0 ,"$3,377 ",$739 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380844,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380844-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380846,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380846-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380848,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380848-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380849,"HDEPO Qualified 424, HSA, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF002,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380849-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,250 ",$10500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ","$1,112 ",$0 ,$0 ,"$3,377 ",$804 ,$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380852,"EPO Copay First 425, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380852-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380854,"EPO Copay First 425, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380854-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380856,"EPO Copay First 425, Bronze, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380856-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380857,"EPO Copay First 425, Bronze, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF008,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380857-01,Standard Bronze On Exchange Plan,58.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,850 ",$13700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,000 ",$12000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,000 ",$782 ,$0 ,$0 ,$0 ,"$1,881 ",$0 ,$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380860,"HDEPO Qualified 430,Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380860-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380862,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380862-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380864,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380864-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP Universal Benefits Inc.,92551,SBE-PUF,1,3/4/2019 0:00,6,SHOP (Small Group),No,16-1520935,92551NY0380865,"HDEPO Qualified 430, Bronze, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",92551NY038,,NYN001,NYS001,NYF003,Existing,EPO,Bronze,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,92551NY0380865-01,Standard Bronze On Exchange Plan,61.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,500 ",$102 ,"$1,047 ",$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,1,Individual,Yes,11-3469326,92786NY0010003,"Pediatric Dental, ST, INN, DP",92786NY001,,NYN001,NYS003,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0010003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$75 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,1,SHOP (Small Group),Yes,11-3469326,92786NY0020003,"Pediatric Dental, ST, INN, DP",92786NY002,,NYN001,NYS003,,Existing,EPO,Low,,Both,,,,,,,,Allows Child-Only,,,,1,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0020003-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,$75 ,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,11-3469326,92786NY0010004,"Family Dental, NS, INN,DP,DEP 29",92786NY001,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0010004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,2,Individual,Yes,11-3469326,92786NY0010005,"Family Dental, NS, INN,DP,DEP 29",92786NY001,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0010005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),Yes,11-3469326,92786NY0020004,"Family Dental, NS, INN,DP,DEP 29",92786NY002,,NYN001,NYS002,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0020004-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,"Healthplex Insurance Company, Inc.",92786,SBE-PUF,1,3/4/2019 0:00,2,SHOP (Small Group),Yes,11-3469326,92786NY0020005,"Family Dental, NS, INN,DP,DEP 29",92786NY002,,NYN001,NYS001,,Existing,EPO,Low,,Both,,,,,,,,Allows Adult and Child-Only,,,,0.0833,Guaranteed Rate,,,,,1/1/2019,12/31/2019,No,,No,,No,,,,,92786NY0020005-01,Standard Low On Exchange Plan,70.00%,,,,No,100%,,$350 ,$700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,,,,,,,,
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280053,"HMO Copayment 10, Platinum, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280053-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280053,"HMO Copayment 10, Platinum, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280053-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280053,"HMO Copayment 10, Platinum, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280053-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280054,"HMO Copayment 20, Gold, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280054-01,Standard Gold On Exchange Plan,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280054,"HMO Copayment 20, Gold, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280054-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280054,"HMO Copayment 20, Gold, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280054-03,Limited Cost Sharing Plan Variation,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,650 ","$1,981 ",$0 ,$0 ,"$1,650 ","$1,532 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$579 ,$0 ,$0 ,$250 ,"$1,102 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280055,"HMO Copayment 30, Silver, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280055-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$373 ,$0 ,$0 ,$0 ,$880 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280064,"HMO Copayment 10, Platinum, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280064-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280064,"HMO Copayment 10, Platinum, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280064-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280064,"HMO Copayment 10, Platinum, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280081,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280064-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280065,"HMO Copayment 20, Gold, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280065-01,Standard Gold On Exchange Plan,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280065,"HMO Copayment 20, Gold, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280065-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280065,"HMO Copayment 20, Gold, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280080,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280065-03,Limited Cost Sharing Plan Variation,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,650 ","$1,981 ",$0 ,$0 ,"$1,650 ","$1,532 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$579 ,$0 ,$0 ,$250 ,"$1,102 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280066,"HMO Copayment 30, Silver, ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280082,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280066-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$373 ,$0 ,$0 ,$0 ,$880 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280080,"HMO Copayment 20, Gold Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280080-01,Standard Gold On Exchange Plan,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280080,"HMO Copayment 20, Gold Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280080-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280080,"HMO Copayment 20, Gold Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280080-03,Limited Cost Sharing Plan Variation,79.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,000 ",$8000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$600 ,$1200 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$600 ,"$1,481 ",$0 ,$0 ,$600 ,"$1,491 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280081,"HMO Copayment 10, Platinum, Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280081-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280081,"HMO Copayment 10, Platinum, Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280081-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280081,"HMO Copayment 10, Platinum, Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF001,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280081-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,000 ",$4000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$931 ,$0 ,$0 ,$0 ,"$1,197 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-01,Standard Silver On Exchange Plan,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-03,Limited Cost Sharing Plan Variation,72.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,700 ",$3400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$2,000 ","$1,981 ",$0 ,$0 ,"$2,000 ","$1,230 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-04,73% AV Level Silver Plan,74.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,075 ",$12150 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,350 ",$2700 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,"$1,650 ","$1,981 ",$0 ,$0 ,"$1,650 ","$1,532 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-05,87% AV Level Silver Plan,87.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$2,100 ",$4200 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$250 ,$500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$250 ,$579 ,$0 ,$0 ,$250 ,"$1,102 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,1,Individual,No,14-1641028,94788NY0280082,"HMO Copayment 30, Silver Child Only, ST, INN",94788NY028,,NYN002,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280082-06,94% AV Level Silver Plan,94.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$1,000 ",$2000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$373 ,$0 ,$0 ,$0 ,$880 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280047,"HDHMO Non-Qualified 50, Catastrophic, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF009,Existing,HMO,Catastrophic,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280047-01,Standard Catastrophic On Exchange Plan,,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$7,350 ",$0 ,$0 ,$0 ,"$3,377 ",$4 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280059,"HDHMO Qualified 40, Bronze, HSA, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280059-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280059,"HDHMO Qualified 40, Bronze, HSA, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280059-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280059,"HDHMO Qualified 40, Bronze, HSA, ST, INN, Dep25",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280059-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280070,"HDHMO Qualified 40, Bronze, HSA,  ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280070-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280070,"HDHMO Qualified 40, Bronze, HSA,  ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280070-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280070,"HDHMO Qualified 40, Bronze, HSA,  ST, INN, Dep29",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult-Only,94788NY0280079,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280070-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280079,"HDHMO Qualified 40, Bronze Child Only, HSA,  ST, INN",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280079-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280079,"HDHMO Qualified 40, Bronze Child Only, HSA,  ST, INN",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280079-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,2,Individual,No,14-1641028,94788NY0280079,"HDHMO Qualified 40, Bronze Child Only, HSA,  ST, INN",94788NY028,,NYN002,NYS001,NYF013,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280079-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,550 ",$13100 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,"$5,500 ",$382 ,$667 ,$0 ,"$3,377 ",$164 ,"$1,850 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260081,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK,Dep25, FP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260081-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260082,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK,Dep25, FP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260082-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260084,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK,Dep25, DP, FP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260084-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,SHOP (Small Group),No,14-1641028,94788NY0260094,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep29, DP, Adult Vision, Wellness, LASIK,Dep25, FP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260094-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280029,"HDHMO Qualified 44, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280029-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ",$0 ,$641 ,$0 ,"$3,377 ",$0 ,$710 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280029,"HDHMO Qualified 44, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280029-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280029,"HDHMO Qualified 44, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280029-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ",$0 ,$641 ,$0 ,"$3,377 ",$0 ,$710 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280129,"HMO Hybrid 13, Platinum, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280129-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$200 ,$204 ,$895 ,$0 ,$0 ,"$1,044 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280129,"HMO Hybrid 13, Platinum, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280129-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280129,"HMO Hybrid 13, Platinum, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280129-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$200 ,$204 ,$895 ,$0 ,$0 ,"$1,044 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280130,"HMO Hybrid 13, Platinum, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280130-01,Standard Platinum On Exchange Plan,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$200 ,$204 ,$895 ,$0 ,$0 ,"$1,044 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280130,"HMO Hybrid 13, Platinum, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280130-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280130,"HMO Hybrid 13, Platinum, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF010,Existing,HMO,Platinum,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280130-03,Limited Cost Sharing Plan Variation,88.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,350 ",$14700 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$200 ,$400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$200 ,$204 ,$895 ,$0 ,$0 ,"$1,044 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280131,"HMO Hybrid 23, Gold, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280131-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500 ",$13000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$750 ,$254 ,"$1,681 ",$0 ,$0 ,"$1,275 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280131,"HMO Hybrid 23, Gold, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280131-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280131,"HMO Hybrid 23, Gold, NS, INN, Dep25",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280131-03,Limited Cost Sharing Plan Variation,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500 ",$13000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$750 ,$254 ,"$1,681 ",$0 ,$0 ,"$1,275 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280132,"HMO Hybrid 23, Gold, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280132-01,Standard Gold On Exchange Plan,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500 ",$13000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$750 ,$254 ,"$1,681 ",$0 ,$0 ,"$1,275 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280132,"HMO Hybrid 23, Gold, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280132-02,Zero Cost Sharing Plan Variation,100.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,3,Individual,No,14-1641028,94788NY0280132,"HMO Hybrid 23, Gold, NS, INN, Dep29",94788NY028,,NYN002,NYS001,NYF004,Existing,HMO,Gold,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280132-03,Limited Cost Sharing Plan Variation,81.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,500 ",$13000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$750 ,$1500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,$750 ,$254 ,"$1,681 ",$0 ,$0 ,"$1,275 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260083,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260083-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260085,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260085-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260087,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260087-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260088,"HDHMO Qualified 324, Silver, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",94788NY026,,NYN001,NYS001,NYF002,Existing,HMO,Silver,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260088-01,Standard Silver On Exchange Plan,71.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,800 ",$9600 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,200 ",$4400 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$2,200 ",$832 ,$0 ,$0 ,"$2,200 ","$1,018 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260091,"HDHMO Smart Deductible 223, Gold,HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260091-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260093,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260093-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260095,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep29, Adult Vision, Wellness, LASIK, DP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260095-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,SHOP (Small Group),No,14-1641028,94788NY0260096,"HDHMO Smart Deductible 223, Gold, HSA, NS, INN, Dep25, Adult Vision, Wellness, LASIK, DP",94788NY026,,NYN001,NYS001,NYF009,New,HMO,Gold,Yes,Both,No,No,,,,,,Allows Adult-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,Yes,,https://www.cdphp.com/Portal/Exchange/WelcomeShop,,www.cdphp.com/Members/Rx-Corner,94788NY0260096-01,Standard Gold On Exchange Plan,76.00%,,No,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,900 ",$15800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,000 ",$2000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,"$1,000 ",$932 ,$0 ,$0 ,"$1,000 ","$1,384 ",$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$266 ,"$1,005 ",$0 ,"$2,500 ",$68 ,$666 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$266 ,"$1,005 ",$0 ,"$2,500 ",$68 ,$666 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450 ",$10900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,300 ",$4600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,250 ",$0 ,$692 ,$0 ,"$2,250 ",$0 ,$475 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280021,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280021-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-01,Standard Silver On Exchange Plan,70.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$266 ,"$1,005 ",$0 ,"$2,500 ",$68 ,$666 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-03,Limited Cost Sharing Plan Variation,70.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,500 ",$5000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,500 ",$266 ,"$1,005 ",$0 ,"$2,500 ",$68 ,$666 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280022,"HDHMO Qualified 33, Silver, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF003,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280022-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$5,450 ",$10900 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$2,300 ",$4600 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$2,250 ",$0 ,$692 ,$0 ,"$2,250 ",$0 ,$475 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280030,"HDHMO Qualified 44, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280030-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ",$0 ,$641 ,$0 ,"$3,377 ",$0 ,$710 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280030,"HDHMO Qualified 44, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280030-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280030,"HDHMO Qualified 44, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF006,Existing,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280030-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$5,500 ",$11000 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$5,250 ",$0 ,$641 ,$0 ,"$3,377 ",$0 ,$710 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280145,"HDHMO Qualified 45, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280145-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280145,"HDHMO Qualified 45, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280145-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280145,"HDHMO Qualified 45, Bronze, HSA,NS, INN, Dep 25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280145-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280146,"HDHMO Qualified 45, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280146-01,Standard Bronze On Exchange Plan,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280146,"HDHMO Qualified 45, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280146-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,4,Individual,No,14-1641028,94788NY0280146,"HDHMO Qualified 45, Bronze, HSA, NS, INN, Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF014,New,HMO,Bronze,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280146-03,Limited Cost Sharing Plan Variation,62.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$6,650 ",$13300 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$6,650 ",$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-01,Standard Silver On Exchange Plan,71.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,750 ",$7500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,300 ",$266 ,$390 ,$0 ,"$4,300 ",$76 ,$446 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-03,Limited Cost Sharing Plan Variation,71.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,750 ",$7500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,300 ",$266 ,$390 ,$0 ,"$4,300 ",$76 ,$446 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900 ",$9800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$0 ,"$2,901 ",$0 ,"$1,750 ",$0 ,"$1,916 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280017,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN, Dep25, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280017-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-01,Standard Silver On Exchange Plan,71.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,750 ",$7500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,300 ",$266 ,$390 ,$0 ,"$4,300 ",$76 ,$446 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-02,Zero Cost Sharing Plan Variation,100.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,$0 ,$0 per group,,,$0 ,$0 per group,$0 ,$0 per group,,,,,,,,,,,,,,,,,,,,,$0 ,$0 per group,0.00%,,,,$0 ,$0 per group,$0 ,$0 per group,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-03,Limited Cost Sharing Plan Variation,71.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$7,500 ",$15000 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$3,750 ",$7500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$4,300 ",$266 ,$390 ,$0 ,"$4,300 ",$76 ,$446 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-04,73% AV Level Silver Plan,73.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,"$4,900 ",$9800 per group,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,"$1,750 ",$3500 per group,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,"$1,750 ",$0 ,"$2,901 ",$0 ,"$1,750 ",$0 ,"$1,916 ",$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-05,87% AV Level Silver Plan,87.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
2019,NY,CDPHP,94788,SBE-PUF,1,3/4/2019 0:00,5,Individual,No,14-1641028,94788NY0280018,"Smart Deductible EPC HMO Coinsurance 34, Silver, NS, INN Dep29, Adult Vision, Lasik, Wellness",94788NY028,,NYN002,NYS001,NYF005,Existing,HMO,Silver,Yes,Both,No,Yes,All,,,,,Allows Adult and Child-Only,,Yes,,,,,,,,1/1/2019,12/31/2019,Yes,Emergency Only,Yes,Emergency Only,No,,https://www.cdphp.com/Portal/Exchange/WelcomeIndividual,,https://www.cdphp.com/Members/Rx-Corner,94788NY0280018-06,94% AV Level Silver Plan,94.00%,,Yes,Yes,No,100%,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,,,,,,,,,,,,,,,,,,,,,Not Applicable,per group not applicable,0.00%,,,,Not Applicable,per group not applicable,Not Applicable,per group not applicable,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 ,$0 
