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	3	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	014	0	1	01	01	H0028_014_0	3	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	015	0	1	02	01	H0028_015_0	3	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	016	0	1	02	01	H0028_016_0	3	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	017	0	1	01	01	H0028_017_0	3	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	029	0	1	01	01	H0028_029_0	3	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	030	0	1	01	01	H0028_030_0	3	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	032	0	1	01	01	H0028_032_0	3	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	033	0	1	01	01	H0028_033_0	3	3	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	034	0	1	01	01	H0028_034_0	3	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	035	0	1	01	01	H0028_035_0	3	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	036	0	1	01	01	H0028_036_0	3	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	037	0	1	01	01	H0028_037_0	3	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	039	0	1	01	01	H0028_039_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H0028	041	0	1	01	01	H0028_041_0	3	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	042	0	1	01	01	H0028_042_0	4	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	043	1	1	01	01	H0028_043_1	4	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	043	2	1	01	01	H0028_043_2	4	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	044	0	1	01	01	H0028_044_0	4	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	045	0	1	01	01	H0028_045_0	4	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	046	0	1	01	01	H0028_046_0	4	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	050	0	1	01	01	H0028_050_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H0028	051	0	1	01	01	H0028_051_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H0028	053	1	1	01	01	H0028_053_1	3	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	053	2	1	01	01	H0028_053_2	3	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	053	3	1	01	01	H0028_053_3	3	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	054	1	1	02	01	H0028_054_1	3	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	054	2	1	02	01	H0028_054_2	3	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	055	0	1	02	01	H0028_055_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H0028	056	0	1	02	01	H0028_056_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H0028	057	0	1	01	01	H0028_057_0	4	1	01111	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	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																		
H0028	058	0	1	01	01	H0028_058_0	4	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H0028	059	0	1	01	01	H0028_059_0	3	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																																				
H0473	001	0	1	04	01	H0473_001_0	4	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																																				
H0473	004	0	1	04	01	H0473_004_0	3	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																																				
H0473	005	0	1	04	01	H0473_005_0	3	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																																				
H0473	006	0	1	04	01	H0473_006_0	3	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																																				
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	047	0	1	01	01	H0504_047_0	5	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	1	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																																																																								
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																																																																								
H0783	002	0	1	01	01	H0783_002_0	3	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																																				
H0783	003	0	1	01	01	H0783_003_0	3	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																																				
H0876	001	0	1	01	01	H0876_001_0	5	1	01100	Identity Theft Insurance	2	2			2			2			2		2			2	2	Sneakers	2	1	100.00	3	2			2			2		2			2	2																																																						
H0907	001	0	1	01	01	H0907_001_0	6	4	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	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	006	0	1	01	01	H1019_006_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	023	0	1	01	01	H1019_023_0	4	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																																				
H1019	026	0	1	01	01	H1019_026_0	3	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																																				
H1019	057	0	1	02	01	H1019_057_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	069	0	1	01	01	H1019_069_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	073	0	1	01	01	H1019_073_0	4	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																																				
H1019	098	0	1	01	01	H1019_098_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	102	0	1	01	01	H1019_102_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	103	1	1	01	01	H1019_103_1	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	103	2	1	01	01	H1019_103_2	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	105	0	1	01	01	H1019_105_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	106	0	1	01	01	H1019_106_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	107	0	1	01	01	H1019_107_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	108	0	1	01	01	H1019_108_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	109	0	1	01	01	H1019_109_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	114	0	1	01	01	H1019_114_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	115	0	1	01	01	H1019_115_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	116	0	1	01	01	H1019_116_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	117	0	1	01	01	H1019_117_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	118	0	1	01	01	H1019_118_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	121	0	1	01	01	H1019_121_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	122	0	1	01	01	H1019_122_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	123	0	1	01	01	H1019_123_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	124	0	1	01	01	H1019_124_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	125	0	1	01	01	H1019_125_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	126	0	1	01	01	H1019_126_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	127	0	1	01	01	H1019_127_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	128	0	1	01	01	H1019_128_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	129	0	1	01	01	H1019_129_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	130	0	1	01	01	H1019_130_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	141	0	1	02	01	H1019_141_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1019	142	0	1	02	01	H1019_142_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	054	0	1	01	01	H1036_054_0	5	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Foot Hygiene Services	2	2			2			2			2		2			1	2																		
H1036	062	0	1	01	01	H1036_062_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	065	0	1	01	01	H1036_065_0	5	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Foot Hygiene Services	2	2			2			2			2		2			1	2																		
H1036	077	0	1	01	01	H1036_077_0	4	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	102	0	1	01	01	H1036_102_0	6	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																																				
H1036	121	0	1	01	01	H1036_121_0	4	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H1036	156	0	1	01	01	H1036_156_0	6	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	167	0	1	02	01	H1036_167_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	168	0	1	02	01	H1036_168_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	175	0	1	01	01	H1036_175_0	4	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																																				
H1036	209	0	1	01	01	H1036_209_0	3	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	210	0	1	01	01	H1036_210_0	3	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	3	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																																				
H1036	214	0	1	01	01	H1036_214_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	230	0	1	01	01	H1036_230_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	231	0	1	01	01	H1036_231_0	3	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	234	0	1	01	01	H1036_234_0	4	1	01111	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	Healthy Living Products	2	1	75.00	7	2			2			2		2			2	2																		
H1036	235	0	1	01	01	H1036_235_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	236	0	1	01	01	H1036_236_0	4	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																																				
H1036	261	0	1	01	01	H1036_261_0	4	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	276	0	1	02	01	H1036_276_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	284	0	1	01	01	H1036_284_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H1036	285	0	1	01	01	H1036_285_0	3	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	292	0	1	01	01	H1036_292_0	4	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H1036	296	0	1	01	01	H1036_296_0	4	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H1036	297	0	1	01	01	H1036_297_0	4	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H1036	298	0	1	01	01	H1036_298_0	4	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H1036	299	0	1	01	01	H1036_299_0	4	1	01000	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																																																																								
H1036	300	0	1	01	01	H1036_300_0	4	1	01000	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																																																																								
H1036	301	0	1	01	01	H1036_301_0	4	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H1036	302	0	1	01	01	H1036_302_0	4	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H1036	303	0	1	01	01	H1036_303_0	4	1	01000	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																																																																								
H1036	304	0	1	01	01	H1036_304_0	4	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	306	0	1	01	01	H1036_306_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	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	2	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H1290	001	0	1	01	01	H1290_001_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	3	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	3	2			2			2		2			1	2																																																																								
H1290	019	0	1	01	01	H1290_019_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	020	0	1	01	01	H1290_020_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	021	0	1	01	01	H1290_021_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	022	0	1	01	01	H1290_022_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	023	0	1	01	01	H1290_023_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	024	0	1	01	01	H1290_024_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	027	0	1	01	01	H1290_027_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	3	2			2			2		2			1	2																																																																								
H1290	033	0	1	01	01	H1290_033_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	034	0	1	01	01	H1290_034_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	036	1	1	01	01	H1290_036_1	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	036	2	1	01	01	H1290_036_2	12	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	3	2			2			2		2			1	2																																																																								
H1290	037	2	1	01	01	H1290_037_2	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	037	3	1	01	01	H1290_037_3	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	037	4	1	01	01	H1290_037_4	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	037	5	1	01	01	H1290_037_5	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	044	1	1	01	01	H1290_044_1	13	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	044	2	1	01	01	H1290_044_2	13	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1290	044	3	1	01	01	H1290_044_3	13	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H1468	017	0	1	01	01	H1468_017_0	4	1	01111	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	Healthy Living Products	2	1	50.00	7	2			2			2		2			2	2																		
H1468	019	0	1	02	01	H1468_019_0	4	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																																				
H1468	020	0	1	02	01	H1468_020_0	3	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																																				
H1608	062	0	1	04	01	H1608_062_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1608	801	0	1	04	01	H1608_801_0	1	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	017	0	1	01	01	H1609_017_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	019	0	1	01	01	H1609_019_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	043	0	1	01	01	H1609_043_0	4	1	01000	Utilities Card	2	2			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	2			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	2			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	2			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	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	048	0	1	01	01	H1609_048_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	049	0	1	01	01	H1609_049_0	5	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	055	0	1	01	01	H1609_055_0	5	1	01000	Utilities Card	2	2			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	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	061	0	1	01	01	H1609_061_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1609	062	0	1	01	01	H1609_062_0	4	1	01000	Utilities Card	2	2			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																																																																								
H1610	001	0	1	01	01	H1610_001_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1610	002	0	1	01	01	H1610_002_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1610	003	0	1	01	01	H1610_003_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H1692	005	0	1	01	01	H1692_005_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	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	7	2			2			2		1	0.00	0.00	2	2																																																																								
H1732	003	0	1	01	01	H1732_003_0	5	4	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1732	007	0	1	01	01	H1732_007_0	7	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	8	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H1799	002	0	1	01	01	H1799_002_0	7	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	6	4	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H1951	044	0	1	01	01	H1951_044_0	7	1	01000	Healthy Living Products	2	1	75.00	7	2			2			2		2			2	2																																																																								
H1993	003	0	1	01	01	H1993_003_0	11	1	01000	Haircuts	2	1	100.00	5	2			2			2		2			1	2																																																																								
H1993	007	0	1	01	01	H1993_007_0	11	1	01000	Haircuts	2	1	150.00	5	2			2			2		2			1	2																																																																								
H1993	008	0	1	01	01	H1993_008_0	11	1	01000	Haircuts	2	1	150.00	5	2			2			2		2			1	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	6	1	01000	Identity Theft Insurance	2	2			2			2			2		2			2	2																																																																								
H2237	001	0	1	01	01	H2237_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																																				
H2456	002	0	1	01	01	H2456_002_0	8	3	01100	Memory Support Kit	2	2			2			2			2		2			2	2	Stress Reduction Kit	2	2			2			2			2		2			2	2																																																						
H2478	001	0	1	01	01	H2478_001_0	8	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2478	002	0	1	01	01	H2478_002_0	9	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2486	003	0	1	01	01	H2486_003_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H2486	007	0	1	01	01	H2486_007_0	2	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																																				
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	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H2697	002	0	1	01	01	H2697_002_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H2697	010	0	1	01	01	H2697_010_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H2697	011	0	1	01	01	H2697_011_0	11	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H2715	001	0	1	01	01	H2715_001_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2879	001	0	1	01	01	H2879_001_0	7	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	7	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	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H2879	005	0	1	01	01	H2879_005_0	8	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H3146	009	0	1	01	01	H3146_009_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	3	1	01000	Utilities Card	2	2			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	5	2	01000	Gas and Utility Allowance	2	1	20.00	7	2			2			2		2			1	1																																																																								
H3443	001	0	1	01	01	H3443_001_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3443	002	0	1	01	01	H3443_002_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3443	002	0	1	01	01	H3443_002_0	5	2	01000	Gas and Utility Allowance	2	1	20.00	7	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	7	5	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	6	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	6	4	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	5	4	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	024	0	1	01	01	H3447_024_0	5	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	6	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	6	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	6	5	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	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H3447	037	0	1	01	01	H3447_037_0	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	038	1	1	01	01	H3447_038_1	5	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	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	042	1	1	01	01	H3447_042_1	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	042	2	1	01	01	H3447_042_2	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	042	3	1	01	01	H3447_042_3	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3447	042	4	1	01	01	H3447_042_4	6	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	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3597	011	0	1	02	01	H3597_011_0	7	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	5	4	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	5	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	6	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	5	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	5	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	6	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	6	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	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H3672	019	0	1	01	01	H3672_019_0	7	3	00010																																					TRANSPORTATION FOR NON-HEALTH RELATED LOCATIONS	2	2			2			2			2		2			2	2																																				
H3672	019	0	1	01	01	H3672_019_0	7	1	01000	Food and Produce	2	1	65.00	7	2			2			2		2			2	2																																																																								
H3672	019	0	1	01	01	H3672_019_0	7	2	00100																			Utility Allowance	2	2			2			2			2		2			2	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	9	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	007	0	1	01	01	H3815_007_0	9	2	01000	Gas and Utility Allowance	2	1	20.00	7	2			2			2		2			1	1																																																																								
H3815	007	0	1	01	01	H3815_007_0	9	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	008	0	1	01	01	H3815_008_0	9	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	010	0	1	01	01	H3815_010_0	7	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	011	0	1	01	01	H3815_011_0	7	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	015	0	1	01	01	H3815_015_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	016	0	1	01	01	H3815_016_0	7	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	026	0	1	02	01	H3815_026_0	7	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	028	0	1	01	01	H3815_028_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	029	0	1	01	01	H3815_029_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	030	0	1	01	01	H3815_030_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	031	0	1	01	01	H3815_031_0	10	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	033	0	1	01	01	H3815_033_0	8	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H3815	035	0	1	01	01	H3815_035_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
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	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H3959	036	0	1	01	01	H3959_036_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H3959	063	0	1	01	01	H3959_063_0	3	1	01000	Utilities Card	2	2			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	8	1	01110	PET CARE	2	1	80.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	80.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	017	0	1	01	01	H4003_017_0	8	1	01110	PET CARE	2	1	145.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	145.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	019	0	1	02	01	H4003_019_0	9	1	01110	PET CARE	2	1	35.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	35.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	034	0	1	02	01	H4003_034_0	8	1	01110	PET CARE	2	1	30.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	30.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	047	0	1	01	01	H4003_047_0	8	2	01000	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																																																								
H4003	049	0	1	01	01	H4003_049_0	11	3	01000	ADDITIONAL ALLOWANCE FOR DEBIT CARD	2	1	50.00	7	2			2			2		2			2	2																																																																								
H4003	049	0	1	01	01	H4003_049_0	11	1	01110	PET CARE	2	1	180.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	180.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	051	0	1	02	01	H4003_051_0	12	1	01000	ADDITIONAL ALLOWANCE FOR DEBIT CARD	2	1	50.00	7	2			2			2		2			2	2																																																																								
H4003	051	0	1	02	01	H4003_051_0	12	2	01110	PET CARE	2	1	100.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	100.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	052	0	1	01	01	H4003_052_0	8	1	01110	PET CARE	2	1	155.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	155.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	053	0	1	01	01	H4003_053_0	10	1	01110	PET CARE	2	1	200.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	200.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	054	0	1	02	01	H4003_054_0	10	1	01110	PET CARE	2	1	50.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	50.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	055	0	1	02	01	H4003_055_0	9	1	01110	PET CARE	2	1	30.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	30.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	057	0	1	02	01	H4003_057_0	9	1	01110	PET CARE	2	1	225.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	225.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4003	058	0	1	01	01	H4003_058_0	9	1	01110	PET CARE	2	1	325.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	325.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4004	048	0	1	01	01	H4004_048_0	8	3	01000	ADDITIONAL ALLOWANCE FOR DEBIT CARD	2	1	50.00	7	2			2			2		2			2	2																																																																								
H4004	048	0	1	01	01	H4004_048_0	8	1	01110	PET CARE	2	1	65.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	65.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4004	056	0	1	02	01	H4004_056_0	9	1	01000	ADDITIONAL ALLOWANCE FOR DEBIT CARD	2	1	50.00	7	2			2			2		2			2	2																																																																								
H4004	056	0	1	02	01	H4004_056_0	9	2	01110	PET CARE	2	1	50.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	50.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4004	062	0	1	01	01	H4004_062_0	11	1	01110	PET CARE	2	1	200.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	200.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4004	063	0	1	02	01	H4004_063_0	9	1	01110	PET CARE	2	1	130.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	130.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4004	065	0	1	02	01	H4004_065_0	8	1	01110	PET CARE	2	1	110.00	7	2			2			2		2			2	2	PERSONAL CARE ITEMS	2	1	110.00	7	2			2			2		2			2	2	ROADSIDE ASSISTANCE, IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	2			2			2		2			2	2																																				
H4141	003	0	1	01	01	H4141_003_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H4141	021	0	1	01	01	H4141_021_0	3	3	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H4461	022	0	1	01	01	H4461_022_0	4	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H4461	038	0	1	01	01	H4461_038_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H4513	062	0	1	01	01	H4513_062_0	3	1	01000	Pet Assistance	2	1	300.00	3	2			2			2		2			2	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																																																																								
H4623	001	0	1	02	01	H4623_001_0	3	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																																				
H4623	002	0	1	02	01	H4623_002_0	3	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																																				
H4711	011	0	1	01	01	H4711_011_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H4711	012	0	1	01	01	H4711_012_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H4711	013	0	1	01	01	H4711_013_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	5	1	01000	Independence and Safe Mobility with AAA	2	2			2			2			2		2			2	2																																																																								
H4982	008	0	1	01	01	H4982_008_0	7	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H4982	009	0	1	01	01	H4982_009_0	5	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H4982	016	0	1	01	01	H4982_016_0	5	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	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																																																																								
H5216	014	0	1	04	01	H5216_014_0	3	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																																				
H5216	032	0	1	04	01	H5216_032_0	3	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																																				
H5216	043	1	1	04	01	H5216_043_1	3	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																																				
H5216	043	6	1	04	01	H5216_043_6	3	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																																				
H5216	062	0	1	04	01	H5216_062_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H5216	068	0	1	04	01	H5216_068_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H5216	081	0	1	04	01	H5216_081_0	3	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																																				
H5216	083	0	1	04	01	H5216_083_0	3	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																																				
H5216	140	0	1	04	01	H5216_140_0	2	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																																				
H5216	164	0	1	04	01	H5216_164_0	3	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																																				
H5216	205	0	1	04	01	H5216_205_0	5	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	206	0	1	04	01	H5216_206_0	4	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	219	0	1	04	01	H5216_219_0	3	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																																				
H5216	220	0	1	04	01	H5216_220_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																																				
H5216	227	0	1	04	01	H5216_227_0	4	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																																				
H5216	228	0	1	04	01	H5216_228_0	3	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																																				
H5216	231	0	1	04	01	H5216_231_0	3	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																																				
H5216	240	0	1	04	01	H5216_240_0	4	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	242	0	1	04	01	H5216_242_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																																				
H5216	243	0	1	04	01	H5216_243_0	4	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																																				
H5216	244	0	1	04	01	H5216_244_0	4	1	01000	Healthy Living Products	2	1	75.00	7	2			2			2		2			2	2																																																																								
H5216	246	0	1	04	01	H5216_246_0	5	1	01000	Healthy Living Products	2	1	75.00	7	2			2			2		2			2	2																																																																								
H5216	254	0	1	04	01	H5216_254_0	3	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																																				
H5216	256	0	1	04	01	H5216_256_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H5216	257	0	1	04	01	H5216_257_0	4	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Foot Hygiene Services	2	2			2			2			2		2			1	2																		
H5216	268	0	1	04	01	H5216_268_0	4	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																																				
H5216	277	0	1	04	01	H5216_277_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	278	2	1	04	01	H5216_278_2	2	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																																				
H5216	286	0	1	04	01	H5216_286_0	2	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	293	0	1	04	01	H5216_293_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	294	0	1	04	01	H5216_294_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5216	296	0	1	04	01	H5216_296_0	4	2	01110	Pet Care Assistance	2	1	3000.00	3	2			2			2		2			1	2	Travel Care Assistance	2	1	3000.00	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	3000.00	3	2			2			2		2			1	2																																				
H5216	304	0	1	04	01	H5216_304_0	5	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H5216	311	0	1	04	01	H5216_311_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H5216	316	1	1	04	01	H5216_316_1	3	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																																				
H5216	316	2	1	04	01	H5216_316_2	3	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																																				
H5216	316	3	1	04	01	H5216_316_3	3	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																																				
H5216	318	1	1	04	01	H5216_318_1	3	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																																				
H5216	318	2	1	04	01	H5216_318_2	3	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																																				
H5216	318	3	1	04	01	H5216_318_3	3	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																																				
H5216	323	0	1	04	01	H5216_323_0	3	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																																				
H5216	329	0	1	04	01	H5216_329_0	2	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																																				
H5216	331	0	1	04	01	H5216_331_0	3	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																																				
H5216	334	0	1	04	01	H5216_334_0	4	1	01000	Healthy Living Products	2	1	75.00	7	2			2			2		2			2	2																																																																								
H5216	337	1	1	04	01	H5216_337_1	3	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																																				
H5216	337	2	1	04	01	H5216_337_2	3	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																																				
H5216	337	3	1	04	01	H5216_337_3	4	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																																				
H5216	352	0	1	04	01	H5216_352_0	3	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																																				
H5216	353	0	1	04	01	H5216_353_0	4	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																																				
H5216	358	0	1	04	01	H5216_358_0	3	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																																				
H5216	360	0	1	04	01	H5216_360_0	3	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																																				
H5296	003	0	1	02	01	H5296_003_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H5296	005	0	1	01	01	H5296_005_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																																																																								
H5325	001	0	1	01	01	H5325_001_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	002	0	1	01	01	H5325_002_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	003	0	1	01	01	H5325_003_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	004	0	1	01	01	H5325_004_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	005	0	1	01	01	H5325_005_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	006	0	1	01	01	H5325_006_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	007	0	1	01	01	H5325_007_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5325	009	0	1	01	01	H5325_009_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H5422	011	0	1	01	01	H5422_011_0	6	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	7	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	6	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H5422	016	0	1	01	01	H5422_016_0	6	5	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	6	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	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	006	0	1	01	01	H5431_006_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	012	0	1	01	01	H5431_012_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	013	0	1	01	01	H5431_013_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	016	0	1	01	01	H5431_016_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	017	0	1	01	01	H5431_017_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	018	0	1	01	01	H5431_018_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	019	0	1	01	01	H5431_019_0	8	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5431	020	0	1	01	01	H5431_020_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5471	083	0	1	01	01	H5471_083_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5471	084	0	1	01	01	H5471_084_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5471	085	0	1	01	01	H5471_085_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5471	105	0	1	01	01	H5471_105_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7	2			2			2		1	0.00	0.00	2	2																																																																								
H5472	001	0	1	01	01	H5472_001_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H5472	001	0	1	01	01	H5472_001_0	5	2	01000	Gas and Utility Allowance	2	1	20.00	7	2			2			2		2			1	1																																																																								
H5472	002	0	1	01	01	H5472_002_0	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
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	3	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	2	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																																																																								
H5521	829	0	1	04	01	H5521_829_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	830	0	2	04	01	H5521_830_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	831	0	1	04	01	H5521_831_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	832	0	1	04	01	H5521_832_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	833	0	1	04	01	H5521_833_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	834	0	1	04	01	H5521_834_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	835	0	2	04	01	H5521_835_0	1	1	01000	At plan sponsor's discretion	2	2			2			2			2		2			2	2																																																																								
H5521	836	0	1	04	01	H5521_836_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	036	0	1	04	01	H5525_036_0	4	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5525	045	0	1	04	01	H5525_045_0	3	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																																				
H5525	053	0	1	04	01	H5525_053_0	2	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5577	002	0	1	01	01	H5577_002_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	005	0	1	01	01	H5577_005_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	008	0	1	02	01	H5577_008_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	014	0	1	01	01	H5577_014_0	5	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	016	0	1	01	01	H5577_016_0	6	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	017	0	1	01	01	H5577_017_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	029	0	1	01	01	H5577_029_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	031	0	1	01	01	H5577_031_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	037	0	1	01	01	H5577_037_0	8	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	038	0	1	01	01	H5577_038_0	8	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	039	0	1	01	01	H5577_039_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	041	0	1	01	01	H5577_041_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	042	0	1	01	01	H5577_042_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	043	0	1	01	01	H5577_043_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	044	0	1	01	01	H5577_044_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	045	0	1	01	01	H5577_045_0	8	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	046	0	1	01	01	H5577_046_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	047	0	1	01	01	H5577_047_0	8	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	049	0	1	01	01	H5577_049_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	050	0	1	02	01	H5577_050_0	6	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	051	0	1	01	01	H5577_051_0	8	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	052	0	1	01	01	H5577_052_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5577	053	0	1	01	01	H5577_053_0	7	1	01111	Home cleaning	2	2			2			2			2		2			2	2	Pet care	2	1	0.00	7	2			2			2		2			2	2	Memory Fitness and Cognitive Function	2	1	0.00	7	2			2			2		2			2	2	Hairstyling	2	2			2			2			2		2			2	2																		
H5593	001	0	1	01	01	H5593_001_0	4	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	055	0	1	01	01	H5619_055_0	5	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H5619	057	0	1	01	01	H5619_057_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	061	0	1	01	01	H5619_061_0	2	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	065	0	1	01	01	H5619_065_0	3	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	069	0	1	02	01	H5619_069_0	3	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	071	0	1	01	01	H5619_071_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	075	0	1	01	01	H5619_075_0	3	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																																				
H5619	076	0	1	01	01	H5619_076_0	3	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																																				
H5619	082	0	1	01	01	H5619_082_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	100	0	1	01	01	H5619_100_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	111	0	1	02	01	H5619_111_0	4	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	113	0	1	01	01	H5619_113_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	122	0	1	01	01	H5619_122_0	3	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	123	0	1	02	01	H5619_123_0	3	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																																				
H5619	126	0	1	01	01	H5619_126_0	3	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																																				
H5619	134	0	1	01	01	H5619_134_0	2	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	136	4	1	01	01	H5619_136_4	3	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																																				
H5619	141	0	1	02	01	H5619_141_0	4	1	01111	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	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																		
H5619	145	0	1	01	01	H5619_145_0	5	1	01111	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2	Healthy Living Product	2	1	225.00	7	2			2			2		2			2	2																		
H5619	152	0	1	01	01	H5619_152_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5619	153	0	1	01	01	H5619_153_0	3	3	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H5628	001	0	1	01	01	H5628_001_0	8	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	7	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	8	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	7	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	7	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	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5793	017	0	1	02	01	H5793_017_0	7	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	7	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	8	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	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5810	016	0	1	01	01	H5810_016_0	7	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	8	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5823	010	0	1	01	01	H5823_010_0	8	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	7	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	5	4	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	6	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	5	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	5	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	7	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	9	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	7	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	5	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	9	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																																																						
H5970	020	0	1	04	01	H5970_020_0	2	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																																				
H5992	007	0	1	01	01	H5992_007_0	11	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H5992	008	0	1	01	01	H5992_008_0	9	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H6316	002	0	1	01	01	H6316_002_0	5	4	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	2	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																																				
H6622	017	0	1	01	01	H6622_017_0	5	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H6622	027	0	1	02	01	H6622_027_0	3	2	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H6622	029	0	1	01	01	H6622_029_0	4	1	01000	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																																																																								
H6622	032	0	1	01	01	H6622_032_0	3	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																																				
H6622	033	0	1	01	01	H6622_033_0	3	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																																				
H6622	035	0	1	01	01	H6622_035_0	4	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H6622	036	0	1	01	01	H6622_036_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H6622	037	0	1	01	01	H6622_037_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H6622	049	0	1	01	01	H6622_049_0	3	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																																				
H6622	071	0	1	01	01	H6622_071_0	4	1	01111	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	Healthy Living Products	2	1	35.00	7	2			2			2		2			2	2																		
H6622	076	0	1	02	01	H6622_076_0	3	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																																				
H6622	077	0	1	02	01	H6622_077_0	3	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																																				
H6622	078	1	1	01	01	H6622_078_1	3	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																																				
H6622	078	2	1	01	01	H6622_078_2	4	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																																				
H7149	006	0	1	01	01	H7149_006_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
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	13	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H7284	007	0	1	04	01	H7284_007_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H7284	008	0	1	04	01	H7284_008_0	3	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H7284	009	0	1	04	01	H7284_009_0	5	1	01000	Foot Hygiene Services	2	2			2			2			2		2			1	2																																																																								
H7284	010	0	1	04	01	H7284_010_0	4	2	01000	Foot Hygiene Services	2	2			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																																																																								
H7559	001	0	1	01	01	H7559_001_0	9	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7559	002	0	1	01	01	H7559_002_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7559	003	0	1	01	01	H7559_003_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7621	001	0	1	01	01	H7621_001_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H7670	001	0	1	01	01	H7670_001_0	7	1	01000	Parking	2	1	50.00	3	2			2			2		2			1	2																																																																								
H7670	002	0	1	01	01	H7670_002_0	7	1	01000	Parking	2	1	50.00	3	2			2			2		2			1	2																																																																								
H7678	001	0	1	01	01	H7678_001_0	7	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	8	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	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H7787	002	0	1	04	01	H7787_002_0	3	1	01000	Pet Assistance	2	1	300.00	3	2			2			2		2			2	2																																																																								
H7849	086	0	1	04	01	H7849_086_0	3	1	01000	Pet Assistance	2	1	300.00	3	2			2			2		2			2	2																																																																								
H7849	089	0	1	04	01	H7849_089_0	3	1	01000	Pet Assistance	2	1	300.00	3	2			2			2		2			2	2																																																																								
H7849	090	0	1	04	01	H7849_090_0	3	1	01000	Pet Assistance	2	1	300.00	3	2			2			2		2			2	2																																																																								
H7993	001	0	1	01	01	H7993_001_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H7993	002	0	1	01	01	H7993_002_0	12	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H7993	003	0	1	01	01	H7993_003_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	3	2			2			2		2			1	2																																																																								
H7993	005	0	1	01	01	H7993_005_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8130	001	0	1	01	01	H8130_001_0	7	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	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H8130	009	0	1	01	01	H8130_009_0	9	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	8	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	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2					Travel Care Assistance	2	1	500	3	2			2			2		2					Barber and Beauty Shop Care	2	1	500	3	2			2			2		2																																								
H8173	001	0	1	01	01	H8173_001_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8173	002	0	1	01	01	H8173_002_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8173	005	0	1	01	01	H8173_005_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8173	007	0	1	01	01	H8173_007_0	10	1	01000	Grocery Delivery Coverage	2	1	240.00	3	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	3	2			2			2		2			1	2																																																																								
H8173	011	0	1	01	01	H8173_011_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8173	014	0	1	01	01	H8173_014_0	9	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8173	015	0	1	01	01	H8173_015_0	5	1	01000	Grocery Delivery Coverage	2	1	240.00	3	2			2			2		2			1	2																																																																								
H8176	001	0	1	01	01	H8176_001_0	8	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	6	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	2	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	2	2																																																																								
H8432	038	1	1	01	01	H8432_038_1	5	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	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H8597	001	0	1	01	01	H8597_001_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H8597	002	0	1	01	01	H8597_002_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H8597	003	0	1	01	01	H8597_003_0	2	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	2																																																																								
H8649	010	0	1	01	01	H8649_010_0	3	1	01000	Utilities Card	2	2			2			2			2		1	0.00	0.00	2	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	9	1	01000	Service Animal Supplies	2	2			2			2			2		2			1	2																																																																								
H8845	002	0	1	01	01	H8845_002_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H9065	001	0	1	01	01	H9065_001_0	5	5	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	5	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	5	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	5	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	3	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																																				
H9070	004	0	1	04	01	H9070_004_0	3	1	01110	Pet Care Assistance	2	1	500	3	2			2			2		2			1	2	Travel Care Assistance	2	1	500	3	2			2			2		2			1	2	Barber and Beauty Shop Care	2	1	500	3	2			2			2		2			1	2																																				
H9070	005	0	1	04	01	H9070_005_0	3	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																																				
H9070	006	1	1	04	01	H9070_006_1	3	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																																				
H9070	006	2	1	04	01	H9070_006_2	3	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																																				
H9070	006	3	1	04	01	H9070_006_3	3	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																																				
H9082	010	0	1	01	01	H9082_010_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H9414	001	0	1	04	01	H9414_001_0	5	1	01000	Sneakers	2	1	50.00	3	2			2			2		2			2	2																																																																								
H9414	002	0	1	04	01	H9414_002_0	5	1	01100	Identity Theft Insurance	2	2			2			2			2		2			2	2	Sneakers	2	1	100.00	3	2			2			2		2			2	2																																																						
H9414	003	0	1	04	01	H9414_003_0	4	1	01100	Identity Theft Insurance	2	2			2			2			2		2			2	2	Sneakers	2	1	50.00	3	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	5	4	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	5	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	5	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	6	4	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	5	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	5	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	5	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	5	1	01000	Service Dog Support	2	1	500.00	3	2			2			2		1	0.00	0.00	1	2																																																																								
H9525	015	0	1	01	01	H9525_015_0	5	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	5	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H9861	003	0	1	01	01	H9861_003_0	6	1	01000	Sneakers	2	1	100.00	3	2			2			2		2			2	2																																																																								
H9876	001	0	1	04	01	H9876_001_0	6	1	01000	Sneakers	2	1	50.00	3	2			2			2		2			2	2																																																																								
H9876	002	0	1	04	01	H9876_002_0	7	1	01100	Identity Theft Insurance	2	2			2			2			2		2			2	2	Sneakers	2	1	100.00	3	2			2			2		2			2	2																																																						
H9943	001	0	1	02	01	H9943_001_0	5	1	01000	Pet Services	2	1	560.00	3	2			2			2		2			1	1				300.00	3																																																																			
H9943	002	0	1	02	01	H9943_002_0	5	1	01000	Pet Services	2	1	560.00	3	2			2			2		2			1	1																																																																								
H9943	003	0	1	01	01	H9943_003_0	6	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
H9943	004	0	1	01	01	H9943_004_0	4	1	01000	Pet Services	2	1	280.00	3	2			2			2		2			1	1																																																																								
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																																																																								
H9955	002	0	1	01	01	H9955_002_0	7	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
H9955	003	0	1	01	01	H9955_003_0	8	1	01000	Service Animal Supplies	2	1	150.00	5	2			2			2		2			1	2																																																																								
