pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_vbid_group_id	pbp_b13i_bendesc_oth	pbp_b13i_o1_bendesc_service	pbp_b13i_o1_bendesc_amo	pbp_b13i_o1_maxplan_yn	pbp_b13i_o1_maxplan_amt	pbp_b13i_o1_maxplan_per	pbp_b13i_o1_maxenr_yn	pbp_b13i_o1_maxenr_amt	pbp_b13i_o1_maxenr_per	pbp_b13i_o1_coins_yn	pbp_b13i_o1_coins_pct_min	pbp_b13i_o1_coins_pct_max	pbp_b13i_o1_ded_yn	pbp_b13i_o1_ded_amt	pbp_b13i_o1_copay_yn	pbp_b13i_o1_copay_amt_min	pbp_b13i_o1_copay_amt_max	pbp_b13i_o1_auth_yn	pbp_b13i_o1_refer_yn	pbp_b13i_o2_bendesc_service	pbp_b13i_o2_bendesc_amo	pbp_b13i_o2_maxplan_yn	pbp_b13i_o2_maxplan_amt	pbp_b13i_o2_maxplan_per	pbp_b13i_o2_maxenr_yn	pbp_b13i_o2_maxenr_amt	pbp_b13i_o2_maxenr_per	pbp_b13i_o2_coins_yn	pbp_b13i_o2_coins_pct_min	pbp_b13i_o2_coins_pct_max	pbp_b13i_o2_ded_yn	pbp_b13i_o2_ded_amt	pbp_b13i_o2_copay_yn	pbp_b13i_o2_copay_amt_min	pbp_b13i_o2_copay_amt_max	pbp_b13i_o2_auth_yn	pbp_b13i_o2_refer_yn	pbp_b13i_o3_bendesc_service	pbp_b13i_o3_bendesc_amo	pbp_b13i_o3_maxplan_yn	pbp_b13i_o3_maxplan_amt	pbp_b13i_o3_maxplan_per	pbp_b13i_o3_maxenr_yn	pbp_b13i_o3_maxenr_amt	pbp_b13i_o3_maxenr_per	pbp_b13i_o3_coins_yn	pbp_b13i_o3_coins_pct_min	pbp_b13i_o3_coins_pct_max	pbp_b13i_o3_ded_yn	pbp_b13i_o3_ded_amt	pbp_b13i_o3_copay_yn	pbp_b13i_o3_copay_amt_min	pbp_b13i_o3_copay_amt_max	pbp_b13i_o3_auth_yn	pbp_b13i_o3_refer_yn	pbp_b13i_o4_bendesc_service	pbp_b13i_o4_bendesc_amo	pbp_b13i_o4_maxplan_yn	pbp_b13i_o4_maxplan_amt	pbp_b13i_o4_maxplan_per	pbp_b13i_o4_maxenr_yn	pbp_b13i_o4_maxenr_amt	pbp_b13i_o4_maxenr_per	pbp_b13i_o4_coins_yn	pbp_b13i_o4_coins_pct_min	pbp_b13i_o4_coins_pct_max	pbp_b13i_o4_ded_yn	pbp_b13i_o4_ded_amt	pbp_b13i_o4_copay_yn	pbp_b13i_o4_copay_amt_min	pbp_b13i_o4_copay_amt_max	pbp_b13i_o4_auth_yn	pbp_b13i_o4_refer_yn	pbp_b13i_o5_bendesc_service	pbp_b13i_o5_bendesc_amo	pbp_b13i_o5_maxplan_yn	pbp_b13i_o5_maxplan_amt	pbp_b13i_o5_maxplan_per	pbp_b13i_o5_maxenr_yn	pbp_b13i_o5_maxenr_amt	pbp_b13i_o5_maxenr_per	pbp_b13i_o5_coins_yn	pbp_b13i_o5_coins_pct_min	pbp_b13i_o5_coins_pct_max	pbp_b13i_o5_ded_yn	pbp_b13i_o5_ded_amt	pbp_b13i_o5_copay_yn	pbp_b13i_o5_copay_amt_min	pbp_b13i_o5_copay_amt_max	pbp_b13i_o5_auth_yn	pbp_b13i_o5_refer_yn
H0028	007	0	1	01	01	H0028_007_0	7	2	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H0028	013	0	1	01	01	H0028_013_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H0028	014	0	1	01	01	H0028_014_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H0028	015	0	1	01	01	H0028_015_0	7	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H0028	018	0	1	01	01	H0028_018_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H0028	050	0	1	01	01	H0028_050_0	5	1	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H0028	051	0	1	01	01	H0028_051_0	5	1	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H0292	001	0	1	01	01	H0292_001_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H0504	031	0	1	01	01	H0504_031_0	5	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H0504	037	0	1	01	01	H0504_037_0	5	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H0504	041	0	1	01	01	H0504_041_0	5	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H0504	046	0	1	01	01	H0504_046_0	5	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H0504	047	0	1	01	01	H0504_047_0	7	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H0523	801	0	1	01	01	H0523_801_0	2	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H0523	805	0	1	01	01	H0523_805_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H0562	121	0	1	01	01	H0562_121_0	4	1	01000	Service Animal	2	1	50.00	6	2			2			2		1	0.00	0.00	1	1																																																																								
H0562	122	0	1	01	01	H0562_122_0	4	1	01000	Service Animal	2	1	50.00	6	2			2			2		1	0.00	0.00	1	1																																																																								
H0628	801	0	1	01	01	H0628_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H0628	802	0	1	01	01	H0628_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H0876	001	0	1	01	01	H0876_001_0	9	1	01000	Identity Theft Insurance	2	2			2			2			2		2			2	2																																																																								
H0907	001	0	1	01	01	H0907_001_0	7	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1019	001	0	1	01	01	H1019_001_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	006	0	1	01	01	H1019_006_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	023	0	1	01	01	H1019_023_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1019	026	0	1	01	01	H1019_026_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1019	057	0	1	02	01	H1019_057_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	069	0	1	01	01	H1019_069_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	073	0	1	01	01	H1019_073_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1019	098	0	1	01	01	H1019_098_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	102	0	1	01	01	H1019_102_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	103	1	1	01	01	H1019_103_1	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	103	2	1	01	01	H1019_103_2	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	105	0	1	01	01	H1019_105_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	106	0	1	01	01	H1019_106_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	107	0	1	01	01	H1019_107_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	108	0	1	01	01	H1019_108_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	109	0	1	01	01	H1019_109_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	114	0	1	01	01	H1019_114_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	115	0	1	01	01	H1019_115_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	116	0	1	01	01	H1019_116_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	117	0	1	01	01	H1019_117_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1019	118	0	1	01	01	H1019_118_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	054	0	1	01	01	H1036_054_0	9	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	062	0	1	01	01	H1036_062_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	065	0	1	01	01	H1036_065_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	077	0	1	01	01	H1036_077_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	102	0	1	01	01	H1036_102_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	103	0	1	01	01	H1036_103_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	104	0	1	01	01	H1036_104_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	156	0	1	01	01	H1036_156_0	8	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	167	0	1	01	01	H1036_167_0	4	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	175	0	1	01	01	H1036_175_0	8	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	209	0	1	01	01	H1036_209_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	210	0	1	01	01	H1036_210_0	6	2	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H1036	213	0	1	01	01	H1036_213_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	214	0	1	01	01	H1036_214_0	6	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	230	0	1	01	01	H1036_230_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	231	0	1	01	01	H1036_231_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	234	0	1	01	01	H1036_234_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	235	0	1	01	01	H1036_235_0	8	2	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H1036	236	0	1	01	01	H1036_236_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	243	0	1	01	01	H1036_243_0	6	2	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H1036	245	0	1	01	01	H1036_245_0	6	2	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H1036	261	0	1	01	01	H1036_261_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	283	0	1	01	01	H1036_283_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	284	0	1	01	01	H1036_284_0	6	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1036	285	0	1	01	01	H1036_285_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1036	296	0	1	01	01	H1036_296_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H1109	801	0	1	01	01	H1109_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1109	802	0	1	01	01	H1109_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1290	001	0	1	01	01	H1290_001_0	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	002	0	1	01	01	H1290_002_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	003	0	1	01	01	H1290_003_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	005	0	1	01	01	H1290_005_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	019	0	1	01	01	H1290_019_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	020	0	1	01	01	H1290_020_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	021	0	1	01	01	H1290_021_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	022	0	1	01	01	H1290_022_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	023	0	1	01	01	H1290_023_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	024	0	1	01	01	H1290_024_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	025	0	1	01	01	H1290_025_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	026	0	1	01	01	H1290_026_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	027	0	1	01	01	H1290_027_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	028	0	1	01	01	H1290_028_0	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	029	0	1	01	01	H1290_029_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	030	0	1	01	01	H1290_030_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	033	0	1	01	01	H1290_033_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	034	0	1	01	01	H1290_034_0	13	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	036	1	1	01	01	H1290_036_1	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	036	2	1	01	01	H1290_036_2	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	037	1	1	01	01	H1290_037_1	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	037	2	1	01	01	H1290_037_2	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	037	3	1	01	01	H1290_037_3	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	038	1	1	01	01	H1290_038_1	9	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1290	038	2	1	01	01	H1290_038_2	9	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H1304	001	0	1	04	01	H1304_001_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	004	0	1	04	01	H1304_004_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	011	1	1	04	01	H1304_011_1	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	011	2	1	04	01	H1304_011_2	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	012	1	1	04	01	H1304_012_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	012	2	1	04	01	H1304_012_2	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	803	0	1	04	01	H1304_803_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	804	0	1	04	01	H1304_804_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	805	0	1	04	01	H1304_805_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1304	806	0	1	04	01	H1304_806_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1468	017	0	1	01	01	H1468_017_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1468	019	0	1	01	01	H1468_019_0	8	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1468	020	0	1	01	01	H1468_020_0	5	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H1608	801	0	1	04	01	H1608_801_0	2	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1608	802	0	1	04	01	H1608_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1609	043	0	1	01	01	H1609_043_0	4	1	01000	Utilities Card	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	044	0	1	01	01	H1609_044_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	045	0	1	01	01	H1609_045_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	046	0	1	01	01	H1609_046_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	047	0	1	01	01	H1609_047_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	048	0	1	01	01	H1609_048_0	6	1	01000	Utilities Card	2	1	50.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	049	0	1	01	01	H1609_049_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	055	0	1	01	01	H1609_055_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	056	0	1	01	01	H1609_056_0	4	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H1609	801	0	1	01	01	H1609_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1609	807	0	1	01	01	H1609_807_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1692	801	0	1	01	01	H1692_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1692	802	0	1	01	01	H1692_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1732	001	0	1	01	01	H1732_001_0	6	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1732	003	0	1	01	01	H1732_003_0	7	3	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1732	004	0	1	01	01	H1732_004_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H1732	007	0	1	01	01	H1732_007_0	8	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H1799	001	0	1	01	01	H1799_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2					5																																																																			
H1799	002	0	1	01	01	H1799_002_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H1947	001	0	1	01	01	H1947_001_0	7	5	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1969	002	0	1	01	01	H1969_002_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	004	0	1	01	01	H1969_004_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	006	0	1	01	01	H1969_006_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	007	3	1	01	01	H1969_007_3	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	007	4	1	01	01	H1969_007_4	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	008	1	1	01	01	H1969_008_1	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1969	008	2	1	01	01	H1969_008_2	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1997	002	0	1	01	01	H1997_002_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1997	008	0	1	01	01	H1997_008_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1997	009	0	1	01	01	H1997_009_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1997	010	0	1	01	01	H1997_010_0	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H1997	011	0	1	01	01	H1997_011_0	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H2056	801	0	1	01	01	H2056_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H2056	802	0	1	01	01	H2056_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H2225	001	0	1	01	01	H2225_001_0	11	1	01000	Identity Theft Insurance	2	2			2			2			2		2			2	2																																																																								
H2237	001	0	1	01	01	H2237_001_0	13	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H2456	002	0	1	01	01	H2456_002_0	6	3	01100	Food & Produce	2	1	30.00	6	2			2			2		2			2	2	Memory Support Kit	2	2			2			2			2		2			2	2																																																						
H2486	003	0	1	01	01	H2486_003_0	8	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H2486	007	0	1	01	01	H2486_007_0	8	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H2593	025	0	1	01	01	H2593_025_0	9	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H2663	805	0	1	01	01	H2663_805_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H2663	810	0	1	01	01	H2663_810_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H2697	001	0	1	01	01	H2697_001_0	8	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H2697	002	0	1	01	01	H2697_002_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H2879	001	0	1	01	01	H2879_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2879	002	0	1	01	01	H2879_002_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2879	003	0	1	01	01	H2879_003_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H3146	801	0	1	01	01	H3146_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3146	802	0	1	01	01	H3146_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3152	801	0	1	01	01	H3152_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3152	804	0	1	01	01	H3152_804_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3192	007	0	1	01	01	H3192_007_0	5	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H3192	801	0	1	01	01	H3192_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3192	802	0	1	01	01	H3192_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3219	801	0	1	04	01	H3219_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3219	802	0	1	04	01	H3219_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3288	801	0	1	04	01	H3288_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3288	802	0	1	04	01	H3288_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3312	801	0	1	01	01	H3312_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3312	804	0	1	01	01	H3312_804_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3443	001	0	1	01	01	H3443_001_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3443	002	0	1	01	01	H3443_002_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3443	003	0	1	01	01	H3443_003_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3447	011	0	1	01	01	H3447_011_0	6	3	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	013	0	1	01	01	H3447_013_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	018	0	1	01	01	H3447_018_0	7	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	020	0	1	01	01	H3447_020_0	10	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	022	0	1	01	01	H3447_022_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	024	0	1	01	01	H3447_024_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	025	0	1	01	01	H3447_025_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	027	0	1	01	01	H3447_027_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	028	0	1	01	01	H3447_028_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	030	0	1	01	01	H3447_030_0	7	3	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	033	0	1	01	01	H3447_033_0	11	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	035	1	1	01	01	H3447_035_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	035	2	1	01	01	H3447_035_2	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	036	1	1	01	01	H3447_036_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	036	2	1	01	01	H3447_036_2	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	037	0	1	01	01	H3447_037_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	1																																																																								
H3447	038	1	1	01	01	H3447_038_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	038	2	1	01	01	H3447_038_2	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3536	006	0	1	01	01	H3536_006_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3597	801	0	1	01	01	H3597_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3597	802	0	1	01	01	H3597_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3655	033	0	1	01	01	H3655_033_0	7	5	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3655	034	0	1	01	01	H3655_034_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	038	0	1	01	01	H3655_038_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	041	0	1	01	01	H3655_041_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	042	0	1	01	01	H3655_042_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	045	1	1	01	01	H3655_045_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	045	2	1	01	01	H3655_045_2	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	045	3	1	01	01	H3655_045_3	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3655	045	4	1	01	01	H3655_045_4	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3748	801	0	1	01	01	H3748_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3748	802	0	1	01	01	H3748_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3815	001	0	1	01	01	H3815_001_0	4	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	006	0	1	01	01	H3815_006_0	3	1	01000	Pet Services	2	1	560.00	3	2			2			2		2			1	1																																																																								
H3815	007	0	1	01	01	H3815_007_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	008	0	1	01	01	H3815_008_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	010	0	1	01	01	H3815_010_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	011	0	1	01	01	H3815_011_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	015	0	1	01	01	H3815_015_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	016	0	1	01	01	H3815_016_0	4	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	018	0	1	01	01	H3815_018_0	3	1	01000	Pet Care Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	025	0	1	01	01	H3815_025_0	3	1	01000	Pet Care Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	026	0	1	01	01	H3815_026_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	027	0	1	01	01	H3815_027_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	028	0	1	01	01	H3815_028_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	029	0	1	01	01	H3815_029_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	030	0	1	01	01	H3815_030_0	4	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	031	0	1	01	01	H3815_031_0	3	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	033	0	1	01	01	H3815_033_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3817	008	1	1	04	01	H3817_008_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	008	2	1	04	01	H3817_008_2	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	009	1	1	04	01	H3817_009_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	009	2	1	04	01	H3817_009_2	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	010	0	1	04	01	H3817_010_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	011	1	1	04	01	H3817_011_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	011	2	1	04	01	H3817_011_2	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	801	0	1	04	01	H3817_801_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	802	0	1	04	01	H3817_802_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	803	0	1	04	01	H3817_803_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3817	804	0	1	04	01	H3817_804_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H3928	801	0	1	01	01	H3928_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3928	803	0	1	01	01	H3928_803_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3931	801	0	1	01	01	H3931_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3931	804	0	1	01	01	H3931_804_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3959	035	0	1	01	01	H3959_035_0	3	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H3959	036	0	1	01	01	H3959_036_0	3	1	01000	Utilities Card	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H3959	803	0	1	01	01	H3959_803_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H3959	804	0	1	01	01	H3959_804_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4003	009	0	1	01	01	H4003_009_0	9	1	01111	PET CARE	2	1	50.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	50.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4003	017	0	1	01	01	H4003_017_0	9	2	01111	PET CARE	2	1	90.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	90.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4003	019	0	1	02	01	H4003_019_0	9	1	01100	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																																																						
H4003	034	0	1	02	01	H4003_034_0	9	1	01111	PET CARE	2	1	20.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	20.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4003	044	0	1	02	01	H4003_044_0	10	1	01100	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																																																						
H4003	047	0	1	01	01	H4003_047_0	11	2	01100	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																																																						
H4003	049	0	1	01	01	H4003_049_0	10	2	01100	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																																																						
H4003	051	0	1	02	01	H4003_051_0	12	1	01111	PET CARE	2	1	60.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	60.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4003	052	0	1	01	01	H4003_052_0	8	1	01111	PET CARE	2	1	110.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	110.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	048	0	1	01	01	H4004_048_0	11	2	01111	PET CARE	2	1	50.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	50.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	056	0	1	02	01	H4004_056_0	11	1	01111	PET CARE	2	1	35.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	35.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	061	0	1	01	01	H4004_061_0	11	2	01111	PET CARE	2	1	75.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	75.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	062	0	1	01	01	H4004_062_0	10	2	01111	PET CARE	2	1	225.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	225.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	063	0	1	02	01	H4004_063_0	9	1	01111	PET CARE	2	1	100.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	100.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	064	0	1	02	01	H4004_064_0	9	1	01111	PET CARE	2	1	200.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	200.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4004	065	0	1	02	01	H4004_065_0	8	1	01111	PET CARE	2	1	60.00	6	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	60.00	6	2			2			2		2			2	2	ROADSIDE ASSISTANCE	2	2			2			2			2		2			2	2	IN-HOME MINOR REPAIRS	2	1	200.00	6	2			2			2		2			2	2																		
H4461	022	0	1	01	01	H4461_022_0	9	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H4461	038	0	1	01	01	H4461_038_0	6	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H4523	801	0	1	01	01	H4523_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4523	802	0	1	01	01	H4523_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4605	001	0	1	04	01	H4605_001_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	002	0	1	04	01	H4605_002_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	004	0	1	04	01	H4605_004_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	007	0	1	04	01	H4605_007_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	008	0	1	04	01	H4605_008_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	009	0	1	04	01	H4605_009_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	801	0	1	04	01	H4605_801_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	802	0	1	04	01	H4605_802_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	803	0	1	04	01	H4605_803_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4605	804	0	1	04	01	H4605_804_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H4623	002	0	1	01	01	H4623_002_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H4711	801	0	1	01	01	H4711_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4711	802	0	1	01	01	H4711_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4835	801	0	1	01	01	H4835_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4835	802	0	1	01	01	H4835_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4937	001	0	1	04	01	H4937_001_0	7	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H4982	801	0	1	01	01	H4982_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H4982	802	0	1	01	01	H4982_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5009	001	0	1	04	01	H5009_001_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	002	0	1	04	01	H5009_002_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	008	0	1	04	01	H5009_008_0	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	009	0	1	04	01	H5009_009_0	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	801	0	1	04	01	H5009_801_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	802	0	1	04	01	H5009_802_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	803	0	1	04	01	H5009_803_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5009	804	0	1	04	01	H5009_804_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5010	001	0	1	04	01	H5010_001_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5010	002	0	1	04	01	H5010_002_0	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5010	007	0	1	04	01	H5010_007_0	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H5216	164	0	1	04	01	H5216_164_0	7	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	165	0	1	04	01	H5216_165_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	166	0	1	04	01	H5216_166_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	205	0	1	04	01	H5216_205_0	7	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	219	0	1	04	01	H5216_219_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5216	220	0	1	04	01	H5216_220_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5216	227	0	1	04	01	H5216_227_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5216	228	0	1	04	01	H5216_228_0	8	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	231	0	1	04	01	H5216_231_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	240	0	1	04	01	H5216_240_0	5	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	242	0	1	04	01	H5216_242_0	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5216	243	0	1	04	01	H5216_243_0	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5216	257	0	1	04	01	H5216_257_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	262	0	1	04	01	H5216_262_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	268	0	1	04	01	H5216_268_0	7	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	277	0	1	04	01	H5216_277_0	6	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	282	2	1	04	01	H5216_282_2	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	286	0	1	04	01	H5216_286_0	3	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	293	0	1	04	01	H5216_293_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	294	0	1	04	01	H5216_294_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	295	0	1	04	01	H5216_295_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5216	296	0	1	04	01	H5216_296_0	9	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5296	001	0	1	01	01	H5296_001_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H5296	003	0	1	02	01	H5296_003_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H5302	809	0	1	01	01	H5302_809_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5302	810	0	1	01	01	H5302_810_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5422	011	0	1	01	01	H5422_011_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5422	013	0	1	01	01	H5422_013_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5422	014	0	1	01	01	H5422_014_0	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5422	015	0	1	01	01	H5422_015_0	9	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5422	016	0	1	01	01	H5422_016_0	7	3	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H5422	017	0	1	01	01	H5422_017_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5431	001	0	1	01	01	H5431_001_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	006	0	1	01	01	H5431_006_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	012	0	1	01	01	H5431_012_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	013	0	1	01	01	H5431_013_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	015	0	1	01	01	H5431_015_0	9	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	016	0	1	01	01	H5431_016_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	017	0	1	01	01	H5431_017_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	018	0	1	01	01	H5431_018_0	7	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	019	0	1	01	01	H5431_019_0	11	1	01000	Personal Hygiene Care	2	1	25.00	6	2			2			2		1	0.00	0.00	2	2																																																																								
H5521	801	0	1	04	01	H5521_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	802	0	1	04	01	H5521_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	805	0	2	04	01	H5521_805_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	806	0	2	04	01	H5521_806_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	809	0	1	04	01	H5521_809_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	810	0	1	04	01	H5521_810_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	812	0	1	04	01	H5521_812_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	814	0	2	04	01	H5521_814_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	815	0	2	04	01	H5521_815_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	816	0	2	04	01	H5521_816_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	817	0	1	04	01	H5521_817_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	818	0	2	04	01	H5521_818_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	819	0	1	04	01	H5521_819_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	820	0	1	04	01	H5521_820_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	821	0	1	04	01	H5521_821_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	822	0	1	04	01	H5521_822_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	823	0	2	04	01	H5521_823_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	824	0	2	04	01	H5521_824_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	825	0	1	04	01	H5521_825_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	826	0	1	04	01	H5521_826_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	827	0	2	04	01	H5521_827_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	828	0	2	04	01	H5521_828_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5522	802	0	1	04	01	H5522_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5522	803	0	1	04	01	H5522_803_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5525	045	0	1	04	01	H5525_045_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5593	801	0	1	01	01	H5593_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5593	802	0	1	01	01	H5593_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5619	057	0	1	01	01	H5619_057_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	061	0	1	01	01	H5619_061_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	071	0	1	01	01	H5619_071_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	073	0	1	01	01	H5619_073_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	075	0	1	01	01	H5619_075_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5619	076	0	1	01	01	H5619_076_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5619	097	0	1	01	01	H5619_097_0	8	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	100	0	1	01	01	H5619_100_0	8	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	111	0	1	01	01	H5619_111_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	113	0	1	01	01	H5619_113_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	123	0	1	01	01	H5619_123_0	6	2	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	126	0	1	01	01	H5619_126_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5619	134	0	1	01	01	H5619_134_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5619	136	4	1	01	01	H5619_136_4	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H5619	141	0	1	01	01	H5619_141_0	5	1	01110	Pet Care Assistance	2	1	1000	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3	2			2			2		2			1	2																																				
H5619	144	1	1	01	01	H5619_144_1	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5619	144	2	1	01	01	H5619_144_2	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H5628	001	0	1	01	01	H5628_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	007	0	1	01	01	H5628_007_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	008	0	1	01	01	H5628_008_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	009	0	1	01	01	H5628_009_0	6	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	010	0	1	01	01	H5628_010_0	6	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	011	0	1	01	01	H5628_011_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5628	012	0	1	01	01	H5628_012_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5793	801	0	1	01	01	H5793_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5793	802	0	1	01	01	H5793_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5810	001	0	1	01	01	H5810_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5810	013	0	1	01	01	H5810_013_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5810	014	0	1	01	01	H5810_014_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5823	006	0	1	01	01	H5823_006_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2					5																																																																			
H5823	010	0	1	01	01	H5823_010_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5823	011	0	1	01	01	H5823_011_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5828	002	0	1	01	01	H5828_002_0	7	5	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H5828	005	0	1	02	01	H5828_005_0	9	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5828	006	0	1	02	01	H5828_006_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5828	008	0	1	01	01	H5828_008_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H5854	013	0	1	01	01	H5854_013_0	6	3	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H5926	001	0	1	01	01	H5926_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5926	005	0	1	01	01	H5926_005_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5926	006	0	1	01	01	H5926_006_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5928	054	0	1	01	01	H5928_054_0	8	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H5943	001	0	1	02	01	H5943_001_0	5	1	01100	Housekeeping	2	1	200.00	3	2			2			2		2			1	1	Pet Care Services	2	1	100.00	3	2			2			2		2			1	1																																																						
H6237	006	0	1	01	01	H6237_006_0	4	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	007	1	1	01	01	H6237_007_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	007	2	1	01	01	H6237_007_2	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	007	3	1	01	01	H6237_007_3	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	008	1	1	01	01	H6237_008_1	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	008	2	1	01	01	H6237_008_2	8	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6237	008	3	1	01	01	H6237_008_3	7	3	01110	Virtual Visit	2	2			2			2			2		2			2	2	Grocery Shopping and Door Drop	2	2			2			2			2		2			2	2	Prescription Pickup and Door Drop	2	2			2			2			2		2			2	2																																				
H6316	001	0	1	01	01	H6316_001_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H6316	002	0	1	01	01	H6316_002_0	8	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H6622	008	0	1	01	01	H6622_008_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	023	0	1	01	01	H6622_023_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	033	0	1	01	01	H6622_033_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	035	0	1	01	01	H6622_035_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	036	0	1	01	01	H6622_036_0	7	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	037	0	1	01	01	H6622_037_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	049	0	1	01	01	H6622_049_0	4	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H6622	064	0	1	01	01	H6622_064_0	9	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	071	0	1	01	01	H6622_071_0	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	076	0	1	01	01	H6622_076_0	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	077	0	1	01	01	H6622_077_0	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	078	1	1	01	01	H6622_078_1	8	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6622	078	2	1	01	01	H6622_078_2	7	2	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H6975	002	0	1	01	01	H6975_002_0	5	1	01000	Service Animal	2	1	50.00	6	2			2			2		1	0.00	0.00	1	1																																																																								
H7149	801	0	1	01	01	H7149_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H7149	802	0	1	01	01	H7149_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H7151	001	0	1	01	01	H7151_001_0	12	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7151	002	0	1	01	01	H7151_002_0	14	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7301	801	0	1	04	01	H7301_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H7301	803	0	1	04	01	H7301_803_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H7621	001	0	1	01	01	H7621_001_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H7678	001	0	1	01	01	H7678_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7678	003	0	1	01	01	H7678_003_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7678	004	0	1	01	01	H7678_004_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7993	001	0	1	01	01	H7993_001_0	8	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7993	002	0	1	01	01	H7993_002_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7993	003	0	1	01	01	H7993_003_0	8	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7993	004	0	1	01	01	H7993_004_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H7993	005	0	1	01	01	H7993_005_0	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8130	001	0	1	01	01	H8130_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8130	008	0	1	01	01	H8130_008_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2					5																																																																			
H8130	009	0	1	01	01	H8130_009_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8130	010	0	1	01	01	H8130_010_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8145	122	0	1	09	04	H8145_122_0	5	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2					Travel Care Assistance	2	1	500.00	3	2			2			2		2					Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2																																								
H8173	001	0	1	01	01	H8173_001_0	8	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	002	0	1	01	01	H8173_002_0	11	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	004	0	1	01	01	H8173_004_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	005	0	1	01	01	H8173_005_0	7	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	006	0	1	01	01	H8173_006_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	007	0	1	01	01	H8173_007_0	8	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	008	0	1	01	01	H8173_008_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8173	010	0	1	01	01	H8173_010_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	6	2			2			2		2			1	2																																																																								
H8176	001	0	1	01	01	H8176_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8176	003	0	1	01	01	H8176_003_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8332	801	0	1	01	01	H8332_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H8332	802	0	1	01	01	H8332_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H8432	034	0	1	01	01	H8432_034_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H8432	035	0	1	01	01	H8432_035_0	6	1	01000	Service Dog Support,	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H8432	038	1	1	01	01	H8432_038_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H8432	038	2	1	01	01	H8432_038_2	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H8649	801	0	1	01	01	H8649_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H8649	803	0	1	01	01	H8649_803_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H8845	001	0	1	01	01	H8845_001_0	7	1	01000	Service Animal Supplies	2	2			2			2			2		2			1	2																																																																								
H9065	001	0	1	01	01	H9065_001_0	7	4	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H9065	002	0	1	02	01	H9065_002_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9065	003	0	1	02	01	H9065_003_0	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9065	004	0	1	02	01	H9065_004_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9065	008	0	1	01	01	H9065_008_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9070	003	0	1	04	01	H9070_003_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H9070	004	0	1	04	01	H9070_004_0	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H9070	006	1	1	04	01	H9070_006_1	6	1	01110	Pet Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3	2			2			2		2			1	2																																				
H9070	006	3	1	04	01	H9070_006_3	6	1	01110	Pet Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3	2			2			2		2			1	2																																				
H9082	009	0	1	01	01	H9082_009_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H9082	010	0	1	01	01	H9082_010_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H9414	002	0	1	04	01	H9414_002_0	13	1	01000	Identity Theft Insurance	2	2			2			2			2		2			2	2																																																																								
H9431	801	0	1	04	01	H9431_801_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H9431	802	0	1	04	01	H9431_802_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H9525	003	0	1	01	01	H9525_003_0	7	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H9525	004	0	1	01	01	H9525_004_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	006	0	1	01	01	H9525_006_0	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	007	0	1	01	01	H9525_007_0	9	5	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H9525	013	1	1	01	01	H9525_013_1	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	013	2	1	01	01	H9525_013_2	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	013	3	1	01	01	H9525_013_3	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	013	4	1	01	01	H9525_013_4	7	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9686	003	0	1	01	01	H9686_003_0	7	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H9686	004	0	1	01	01	H9686_004_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H9876	002	0	1	04	01	H9876_002_0	10	1	01000	Identity Theft Insurance	2	2			2			2			2		2			2	2																																																																								
H9955	001	0	1	01	01	H9955_001_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2					5																																																																			
H9955	002	0	1	01	01	H9955_002_0	5	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
