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_maxplan_per_d	pbp_b13i_o1_maxenr_yn	pbp_b13i_o1_maxenr_amt	pbp_b13i_o1_maxenr_per	pbp_b13i_o1_maxenr_per_d	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_maxplan_per_d	pbp_b13i_o2_maxenr_yn	pbp_b13i_o2_maxenr_amt	pbp_b13i_o2_maxenr_per	pbp_b13i_o2_maxenr_per_d	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_maxplan_per_d	pbp_b13i_o3_maxenr_yn	pbp_b13i_o3_maxenr_amt	pbp_b13i_o3_maxenr_per	pbp_b13i_o3_maxenr_per_d	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_maxplan_per_d	pbp_b13i_o4_maxenr_yn	pbp_b13i_o4_maxenr_amt	pbp_b13i_o4_maxenr_per	pbp_b13i_o4_maxenr_per_d	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_maxplan_per_d	pbp_b13i_o5_maxenr_amt	pbp_b13i_o5_maxenr_per	pbp_b13i_o5_maxenr_per_d	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	6	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	014	0	1	01	01	H0028_014_0	8	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	7	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H0028	016	0	1	02	01	H0028_016_0	8	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	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																																								
H0028	039	0	1	01	01	H0028_039_0	7	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H0028	041	0	1	01	01	H0028_041_0	7	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	8	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	10	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	8	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	7	1	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	053	3	1	01	01	H0028_053_3	7	1	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H0028	054	1	1	02	01	H0028_054_1	7	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	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																																								
H0028	055	0	1	02	01	H0028_055_0	6	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	8	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	6	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	35.00	7		2				2			2		2			2	2																				
H0028	058	0	1	01	01	H0028_058_0	7	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	060	0	1	01	01	H0028_060_0	5	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H0028	064	0	1	01	01	H0028_064_0	7	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																																								
H0363	001	0	1	01	01	H0363_001_0	9	1	01000	Beauty Benefit	2	2				2				2			2		2			2	2																																																																																
H0504	041	0	1	01	01	H0504_041_0	7	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	6	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	10	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0523	805	0	1	01	01	H0523_805_0	10	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0628	001	0	1	02	01	H0628_001_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	001	0	1	02	01	H0628_001_0	8	3	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	003	0	1	02	01	H0628_003_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	005	0	1	02	01	H0628_005_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	005	0	1	02	01	H0628_005_0	8	3	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	009	0	1	02	01	H0628_009_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	012	0	1	01	01	H0628_012_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	013	0	1	01	01	H0628_013_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	014	0	1	01	01	H0628_014_0	3	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	015	0	1	01	01	H0628_015_0	3	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	017	0	1	02	01	H0628_017_0	7	3	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	017	0	1	02	01	H0628_017_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	801	0	1	01	01	H0628_801_0	9	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0628	802	0	1	01	01	H0628_802_0	7	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0876	001	0	1	01	01	H0876_001_0	10	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																																																												
H1019	001	0	1	01	01	H1019_001_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																																								
H1019	006	0	1	01	01	H1019_006_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																																								
H1019	023	0	1	01	01	H1019_023_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																																								
H1019	026	0	1	01	01	H1019_026_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																																								
H1019	057	0	1	02	01	H1019_057_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																																								
H1019	069	0	1	01	01	H1019_069_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																																								
H1019	073	0	1	01	01	H1019_073_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																																								
H1019	098	0	1	01	01	H1019_098_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																																								
H1019	102	0	1	01	01	H1019_102_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																																								
H1019	103	1	1	01	01	H1019_103_1	5	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	5	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	13	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	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																																								
H1019	117	0	1	01	01	H1019_117_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																																								
H1019	118	0	1	01	01	H1019_118_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																																								
H1019	121	0	1	01	01	H1019_121_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																																								
H1019	122	0	1	01	01	H1019_122_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																																								
H1019	123	0	1	01	01	H1019_123_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																																								
H1019	124	0	1	01	01	H1019_124_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																																								
H1019	125	0	1	01	01	H1019_125_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																																								
H1019	130	0	1	01	01	H1019_130_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																																								
H1019	141	0	1	02	01	H1019_141_0	11	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	5	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	145	0	1	01	01	H1019_145_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																																								
H1019	146	0	1	01	01	H1019_146_0	5	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	054	0	1	01	01	H1036_054_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	062	0	1	01	01	H1036_062_0	7	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	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	077	0	1	01	01	H1036_077_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	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	6	1	01000	Healthy Living Products	2	1	35.00	7		2				2			2		2			2	2																																																																																
H1036	167	0	1	01	01	H1036_167_0	7	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	209	0	1	01	01	H1036_209_0	7	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	210	0	1	01	01	H1036_210_0	7	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H1036	213	0	1	01	01	H1036_213_0	7	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	7	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	7	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	234	0	1	01	01	H1036_234_0	7	1	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H1036	235	0	1	01	01	H1036_235_0	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	7	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	285	0	1	01	01	H1036_285_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	292	0	1	01	01	H1036_292_0	7	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H1036	297	0	1	01	01	H1036_297_0	6	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	5	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	6	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	6	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	7	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	6	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	304	0	1	01	01	H1036_304_0	5	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	6	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																				
H1036	307	0	1	01	01	H1036_307_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																																								
H1036	308	0	1	01	01	H1036_308_0	5	2	01000	Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2																																																																																
H1036	309	0	1	01	01	H1036_309_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																																								
H1036	312	0	1	01	01	H1036_312_0	5	2	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H1036	313	0	1	01	01	H1036_313_0	5	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H1036	314	0	1	01	01	H1036_314_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	315	0	1	01	01	H1036_315_0	6	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	316	0	1	01	01	H1036_316_0	6	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																				
H1109	801	0	1	01	01	H1109_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1109	802	0	1	01	01	H1109_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1206	801	0	1	01	01	H1206_801_0	3	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H1206	802	0	1	01	01	H1206_802_0	3	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1277	002	0	1	02	01	H1277_002_0	10	1	01000	Cognitive Member Kit	2	2				2				2			2		2			2	2																																																																																
H1426	001	0	1	01	01	H1426_001_0	11	1	01000	Identity Theft	2	2				2				2			2		2			2	2																																																																																
H1426	002	0	1	01	01	H1426_002_0	12	1	01000	Identity Theft	2	2				2				2			2		2			2	2																																																																																
H1468	017	0	1	01	01	H1468_017_0	7	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																				
H1587	003	0	1	02	01	H1587_003_0	11	1	01000	Memory Activity Box	2	1	100.00	3		2				2			2		2			2	2																																																																																
H1608	062	0	1	04	01	H1608_062_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	073	0	1	04	01	H1608_073_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	075	0	1	04	01	H1608_075_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	076	0	1	04	01	H1608_076_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	077	0	1	04	01	H1608_077_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	078	0	1	04	01	H1608_078_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	801	0	1	04	01	H1608_801_0	8	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H1608	802	0	1	04	01	H1608_802_0	8	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H1609	016	0	1	01	01	H1609_016_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	017	0	1	01	01	H1609_017_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	018	0	1	01	01	H1609_018_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	019	0	1	01	01	H1609_019_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	020	0	1	01	01	H1609_020_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	021	0	1	01	01	H1609_021_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	022	0	1	01	01	H1609_022_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	025	0	1	01	01	H1609_025_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	027	0	1	01	01	H1609_027_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	042	0	1	01	01	H1609_042_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	043	0	1	01	01	H1609_043_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	044	0	1	01	01	H1609_044_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	045	0	1	01	01	H1609_045_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	046	0	1	01	01	H1609_046_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	047	0	1	01	01	H1609_047_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	048	0	1	01	01	H1609_048_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	049	0	1	01	01	H1609_049_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	055	0	1	01	01	H1609_055_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	056	0	1	01	01	H1609_056_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	059	0	1	01	01	H1609_059_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	061	0	1	01	01	H1609_061_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	062	0	1	01	01	H1609_062_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	064	0	1	01	01	H1609_064_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	065	0	1	01	01	H1609_065_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	066	0	1	01	01	H1609_066_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	067	0	1	01	01	H1609_067_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	801	0	1	01	01	H1609_801_0	7	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H1609	807	0	1	01	01	H1609_807_0	7	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H1610	001	0	1	01	01	H1610_001_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1610	002	0	1	01	01	H1610_002_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1610	003	0	1	01	01	H1610_003_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1692	005	0	1	01	01	H1692_005_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1692	801	0	1	01	01	H1692_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1692	802	0	1	01	01	H1692_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1748	010	0	1	01	01	H1748_010_0	10	1	00110																					Mobility Devices	2	1	2500.00	1		2				2			2		2			1	2	Cosmetic/Elective Procedures	2	1	3500.00	3		2				2			2		2			1	2																																								
H1799	001	0	1	01	01	H1799_001_0	6	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																																																																																
H1951	044	0	1	01	01	H1951_044_0	6	1	01000	Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2																																																																																
H1993	007	0	1	01	01	H1993_007_0	12	1	01000	Haircuts	2	1	0.00	7		2				2			2		2			1	2																																																																																
H1993	008	0	1	01	01	H1993_008_0	11	1	01000	Haircuts	2	1	0.00	7		2				2			2		2			1	2																																																																																
H1993	010	0	1	01	01	H1993_010_0	13	1	01000	Haircuts	2	1	0.00	7		2				2			2		2			1	2																																																																																
H2056	801	0	1	01	01	H2056_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2056	802	0	1	01	01	H2056_802_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H2225	001	0	1	01	01	H2225_001_0	9	1	01000	Identity Theft Insurance	2	2				2				2			2		2			2	2																																																																																
H2237	001	0	1	01	01	H2237_001_0	7	1	01110	Pet Care Assistance	2	1	500.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	500.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	500.00	3		2				2			2		2			1	2																																								
H2293	001	0	1	04	01	H2293_001_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	002	0	1	04	01	H2293_002_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	002	0	1	04	01	H2293_002_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	003	0	1	04	01	H2293_003_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	003	0	1	04	01	H2293_003_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	004	0	1	04	01	H2293_004_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	004	0	1	04	01	H2293_004_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	005	0	1	04	01	H2293_005_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	005	0	1	04	01	H2293_005_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	006	0	1	04	01	H2293_006_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	007	0	1	04	01	H2293_007_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	007	0	1	04	01	H2293_007_0	5	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	008	0	1	04	01	H2293_008_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	009	0	1	04	01	H2293_009_0	2	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	011	0	1	04	01	H2293_011_0	5	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	021	0	1	04	01	H2293_021_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	022	0	1	04	01	H2293_022_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	023	0	1	04	01	H2293_023_0	4	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	023	0	1	04	01	H2293_023_0	4	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2456	002	0	1	01	01	H2456_002_0	8	2	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	5	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	7	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H2486	007	0	1	01	01	H2486_007_0	7	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	067	0	1	01	01	H2663_067_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	067	0	1	01	01	H2663_067_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	805	0	1	01	01	H2663_805_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2663	810	0	1	01	01	H2663_810_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2715	001	0	1	01	01	H2715_001_0	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H2819	002	0	1	01	01	H2819_002_0	6	1	01000	Independence and Safe Mobility with AAA	2	2				2				2			2		2			2	2																																																																																
H2879	001	0	1	01	01	H2879_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H2879	002	0	1	01	01	H2879_002_0	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H2879	003	0	1	01	01	H2879_003_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H2879	005	0	1	01	01	H2879_005_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H3038	001	0	1	01	01	H3038_001_0	4	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H3038	002	0	1	01	01	H3038_002_0	4	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H3038	003	0	1	01	01	H3038_003_0	3	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H3146	002	0	1	01	01	H3146_002_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	003	0	1	01	01	H3146_003_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	006	0	1	01	01	H3146_006_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	008	0	1	01	01	H3146_008_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	009	0	1	01	01	H3146_009_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	011	0	1	01	01	H3146_011_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	012	0	1	01	01	H3146_012_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	013	0	1	01	01	H3146_013_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	015	0	1	01	01	H3146_015_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	016	0	1	01	01	H3146_016_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	017	0	1	01	01	H3146_017_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	018	0	1	01	01	H3146_018_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	019	0	1	01	01	H3146_019_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	801	0	1	01	01	H3146_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3146	802	0	1	01	01	H3146_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3152	801	0	1	01	01	H3152_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3152	804	0	1	01	01	H3152_804_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3192	007	0	1	01	01	H3192_007_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3192	007	0	1	01	01	H3192_007_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3192	801	0	1	01	01	H3192_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3192	802	0	1	01	01	H3192_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3219	007	0	1	04	01	H3219_007_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3219	801	0	1	04	01	H3219_801_0	9	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H3219	802	0	1	04	01	H3219_802_0	9	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H3239	001	0	1	01	01	H3239_001_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	002	0	1	01	01	H3239_002_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	003	0	1	01	01	H3239_003_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	005	0	1	01	01	H3239_005_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	006	0	1	01	01	H3239_006_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	007	0	1	01	01	H3239_007_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	008	0	1	01	01	H3239_008_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	010	0	1	01	01	H3239_010_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	011	0	1	01	01	H3239_011_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	012	0	1	01	01	H3239_012_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	013	0	1	01	01	H3239_013_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	013	0	1	01	01	H3239_013_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	015	0	1	01	01	H3239_015_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	015	0	1	01	01	H3239_015_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	016	0	1	01	01	H3239_016_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	016	0	1	01	01	H3239_016_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	017	0	1	01	01	H3239_017_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	017	0	1	01	01	H3239_017_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	018	0	1	01	01	H3239_018_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	018	0	1	01	01	H3239_018_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	019	0	1	01	01	H3239_019_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	019	0	1	01	01	H3239_019_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	020	0	1	01	01	H3239_020_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	020	0	1	01	01	H3239_020_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3274	003	0	1	01	01	H3274_003_0	11	1	01000	Cognitive Member Kit	2	2				2				2			2		2			2	2																																																																																
H3288	034	0	1	04	01	H3288_034_0	3	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	801	0	1	04	01	H3288_801_0	8	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H3288	802	0	1	04	01	H3288_802_0	8	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H3312	069	0	1	01	01	H3312_069_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	070	0	1	01	01	H3312_070_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	073	0	1	01	01	H3312_073_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	801	0	1	01	01	H3312_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3312	804	0	1	01	01	H3312_804_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3419	003	0	1	01	01	H3419_003_0	10	1	01000	Beauty/Barber Shop Benefit	2	1	0.00	7		2				2			2		2			2	2																																																																																
H3419	004	0	1	01	01	H3419_004_0	11	1	01000	Beauty/Barber Shop Benefit	2	1	0.00	7		2				2			2		2			2	2																																																																																
H3443	001	0	1	01	01	H3443_001_0	16	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3443	002	0	1	01	01	H3443_002_0	16	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3443	003	0	1	01	01	H3443_003_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3443	005	0	1	01	01	H3443_005_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3443	006	0	1	01	01	H3443_006_0	13	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3597	011	0	1	02	01	H3597_011_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3597	012	0	1	02	01	H3597_012_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3597	801	0	1	01	01	H3597_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3597	802	0	1	01	01	H3597_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3748	801	0	1	01	01	H3748_801_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H3748	802	0	1	01	01	H3748_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3815	001	0	1	01	01	H3815_001_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	007	0	1	01	01	H3815_007_0	19	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	008	0	1	01	01	H3815_008_0	19	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	010	0	1	01	01	H3815_010_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	011	0	1	01	01	H3815_011_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	013	0	1	01	01	H3815_013_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	016	0	1	02	01	H3815_016_0	17	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	019	0	1	01	01	H3815_019_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	020	0	1	01	01	H3815_020_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	021	0	1	01	01	H3815_021_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	023	0	1	01	01	H3815_023_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	026	0	1	02	01	H3815_026_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	028	0	1	01	01	H3815_028_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	030	0	1	01	01	H3815_030_0	15	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	031	0	1	01	01	H3815_031_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	033	0	1	01	01	H3815_033_0	11	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	034	0	1	01	01	H3815_034_0	16	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	035	0	1	01	01	H3815_035_0	16	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	036	0	1	01	01	H3815_036_0	17	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	037	0	1	01	01	H3815_037_0	15	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	038	0	1	01	01	H3815_038_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3815	039	0	1	01	01	H3815_039_0	16	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H3815	040	0	1	01	01	H3815_040_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H3928	001	0	1	01	01	H3928_001_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3928	801	0	1	01	01	H3928_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3928	803	0	1	01	01	H3928_803_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H3931	159	0	1	01	01	H3931_159_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	801	0	1	01	01	H3931_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3931	804	0	1	01	01	H3931_804_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3959	033	0	1	02	01	H3959_033_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	033	0	1	02	01	H3959_033_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	035	0	1	01	01	H3959_035_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	035	0	1	01	01	H3959_035_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	036	0	1	01	01	H3959_036_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	036	0	1	01	01	H3959_036_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	052	0	1	02	01	H3959_052_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	052	0	1	02	01	H3959_052_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	063	0	1	01	01	H3959_063_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	803	0	1	01	01	H3959_803_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H3959	804	0	1	01	01	H3959_804_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4003	009	0	1	01	01	H4003_009_0	7	1	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	017	0	1	01	01	H4003_017_0	7	1	01100	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																																																												
H4003	017	0	1	01	01	H4003_017_0	7	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	019	0	1	02	01	H4003_019_0	5	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	019	0	1	02	01	H4003_019_0	5	1	01100	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																																																												
H4003	034	0	1	02	01	H4003_034_0	6	1	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE WILL ONLY APPLY FOR ROADSIDEASSISTANCE AND IN-HOME MINOR REPAIRS.	2				2			2		2			2	2																																																																																
H4003	049	0	1	01	01	H4003_049_0	6	1	01100	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																																																												
H4003	049	0	1	01	01	H4003_049_0	6	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	054	0	1	02	01	H4003_054_0	5	1	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	055	0	1	02	01	H4003_055_0	6	1	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	058	0	1	01	01	H4003_058_0	6	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	058	0	1	01	01	H4003_058_0	6	1	01100	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																																																												
H4004	048	0	1	01	01	H4004_048_0	6	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	048	0	1	01	01	H4004_048_0	6	1	01100	PET CARE	2	1	85.00	7		2				2			2		2			2	2	PERSONAL CARE ITEMS	2	1	85.00	7		2				2			2		2			2	2																																																												
H4004	056	0	1	02	01	H4004_056_0	5	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	056	0	1	02	01	H4004_056_0	5	1	01100	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																																																												
H4004	062	0	1	01	01	H4004_062_0	6	1	01100	PET CARE	2	1	120.00	7		2				2			2		2			2	2	PERSONAL CARE ITEMS	2	1	120.00	7		2				2			2		2			2	2																																																												
H4004	062	0	1	01	01	H4004_062_0	6	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	063	0	1	02	01	H4004_063_0	5	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	063	0	1	02	01	H4004_063_0	5	1	01100	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																																																												
H4004	065	0	1	02	01	H4004_065_0	5	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	065	0	1	02	01	H4004_065_0	5	1	01100	PET CARE	2	1	60.00	7		2				2			2		2			2	2	PERSONAL CARE ITEMS	2	1	60.00	7		2				2			2		2			2	2																																																												
H4004	066	0	1	02	01	H4004_066_0	4	1	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	067	0	1	01	01	H4004_067_0	6	1	01100	PET CARE	2	1	15.00	7		2				2			2		2			2	2	PERSONAL CARE ITEMS	2	1	15.00	7		2				2			2		2			2	2																																																												
H4004	067	0	1	01	01	H4004_067_0	6	2	01000	ROADSIDE ASSISTANCE/IN-HOME MINOR REPAIRS & OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOME MINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4141	003	0	1	01	01	H4141_003_0	8	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	6	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																																								
H4172	001	0	1	01	01	H4172_001_0	4	1	01000	Beauty and Barber Shop	2	2				2				2			2		2			2	2																																																																																
H4279	001	0	1	01	01	H4279_001_0	8	3	01000	Wellness Box	2	2				2				2			2		2			2	2																																																																																
H4279	004	0	1	01	01	H4279_004_0	8	3	01000	Wellness Box	2	2				2				2			2		2			2	2																																																																																
H4286	001	0	1	01	01	H4286_001_0	10	1	01000	Pet care and Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4286	002	0	1	01	01	H4286_002_0	11	1	01000	Pet Care and Supplies	2	2				2				2			2		2			2	2																																																																																
H4461	022	0	1	01	01	H4461_022_0	9	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	7	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	042	0	1	01	01	H4461_042_0	7	1	01000	Healthy Living Products	2	1	100.00	7		2				2			2		2			2	2																																																																																
H4513	009	0	1	01	01	H4513_009_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H4523	801	0	1	01	01	H4523_801_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4523	802	0	1	01	01	H4523_802_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4623	001	0	1	02	01	H4623_001_0	12	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	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																																								
H4711	011	0	1	01	01	H4711_011_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	012	0	1	01	01	H4711_012_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	013	0	1	01	01	H4711_013_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	801	0	1	01	01	H4711_801_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4711	802	0	1	01	01	H4711_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4835	801	0	1	01	01	H4835_801_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4835	802	0	1	01	01	H4835_802_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4937	001	0	1	04	01	H4937_001_0	6	1	01000	Independence and Safe Mobility with AAA	2	2				2				2			2		2			2	2																																																																																
H4961	001	0	1	04	01	H4961_001_0	13	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H4961	003	0	1	04	01	H4961_003_0	13	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H4961	006	0	1	04	01	H4961_006_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H4961	007	0	1	04	01	H4961_007_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H4961	008	0	1	04	01	H4961_008_0	11	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H4982	801	0	1	01	01	H4982_801_0	8	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4982	802	0	1	01	01	H4982_802_0	8	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5163	001	0	1	01	01	H5163_001_0	9	1	01100	Beauty Spa	2	1	70.00	5		2				2			2		2			2	2	Pet Care	2	1	50.00	5		2				2			2		2			2	2																																																												
H5163	002	0	1	01	01	H5163_002_0	8	1	01000	Beauty Spa	2	1	50.00	5		2				2			2		2			2	2																																																																																
H5178	002	0	1	01	01	H5178_002_0	5	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	014	0	1	04	01	H5216_014_0	8	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	9	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	5	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H5216	068	0	1	04	01	H5216_068_0	6	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H5216	083	0	1	04	01	H5216_083_0	9	1	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	140	0	1	04	01	H5216_140_0	11	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	8	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	205	0	1	04	01	H5216_205_0	11	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	8	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	220	0	1	04	01	H5216_220_0	7	2	01110	Pet Care Assistance	2	1	750.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	750.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	750.00	3		2				2			2		2			1	2																																								
H5216	227	0	1	04	01	H5216_227_0	7	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	242	0	1	04	01	H5216_242_0	7	1	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	243	0	1	04	01	H5216_243_0	7	1	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	244	0	1	04	01	H5216_244_0	6	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H5216	246	0	1	04	01	H5216_246_0	6	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H5216	254	0	1	04	01	H5216_254_0	7	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	5	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H5216	257	0	1	04	01	H5216_257_0	7	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	7	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	277	0	1	04	01	H5216_277_0	7	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	286	0	1	04	01	H5216_286_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																																								
H5216	293	0	1	04	01	H5216_293_0	9	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	304	0	1	04	01	H5216_304_0	6	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H5216	311	0	1	04	01	H5216_311_0	6	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H5216	318	1	1	04	01	H5216_318_1	7	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	7	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	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																																								
H5216	329	0	1	04	01	H5216_329_0	10	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	334	0	1	04	01	H5216_334_0	6	1	01000	Healthy Living Products	2	1	900.00	3		2				2			2		2			2	2																																																																																
H5216	362	0	1	04	01	H5216_362_0	8	1	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	366	0	1	04	01	H5216_366_0	5	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H5216	369	0	1	04	01	H5216_369_0	10	1	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	372	0	1	04	01	H5216_372_0	5	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H5216	373	0	1	04	01	H5216_373_0	8	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H5216	375	0	1	04	01	H5216_375_0	5	1	01000	Healthy Living Products	2	1	50.00	7		2				2			2		2			2	2																																																																																
H5216	377	0	1	04	01	H5216_377_0	6	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5216	400	0	1	04	01	H5216_400_0	6	1	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	401	0	1	04	01	H5216_401_0	7	1	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																																								
H5296	003	0	1	02	01	H5296_003_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5296	004	0	1	02	01	H5296_004_0	13	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H5296	005	0	1	02	01	H5296_005_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5296	006	0	1	01	01	H5296_006_0	10	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5296	007	0	1	01	01	H5296_007_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5296	008	0	1	01	01	H5296_008_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5302	012	0	1	01	01	H5302_012_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	012	0	1	01	01	H5302_012_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	013	0	1	01	01	H5302_013_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	014	0	1	01	01	H5302_014_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	020	0	1	01	01	H5302_020_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	809	0	1	01	01	H5302_809_0	7	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5302	810	0	1	01	01	H5302_810_0	7	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5325	001	0	1	01	01	H5325_001_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	002	0	1	01	01	H5325_002_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	003	0	1	01	01	H5325_003_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	004	0	1	01	01	H5325_004_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	005	0	1	01	01	H5325_005_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	006	0	1	01	01	H5325_006_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	007	0	1	01	01	H5325_007_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	009	0	1	01	01	H5325_009_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	010	0	1	01	01	H5325_010_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	010	0	1	01	01	H5325_010_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	011	0	1	01	01	H5325_011_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	011	0	1	01	01	H5325_011_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5374	001	0	1	01	01	H5374_001_0	8	1	01000	Beauty Benefit	2	2				2				2			2		2			2	2																																																																																
H5410	057	0	1	01	01	H5410_057_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H5410	058	0	1	01	01	H5410_058_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H5427	070	0	1	01	01	H5427_070_0	10	1	01000	Paper/Non-Food Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	072	0	1	01	01	H5427_072_0	8	1	01000	Paper/Non-Food Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	077	0	1	01	01	H5427_077_0	8	1	01000	Non-Food Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	078	0	1	01	01	H5427_078_0	10	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	087	0	1	01	01	H5427_087_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	099	0	1	01	01	H5427_099_0	7	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5427	108	0	1	01	01	H5427_108_0	6	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5431	001	0	1	01	01	H5431_001_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																												
H5431	006	0	1	01	01	H5431_006_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																												
H5431	012	0	1	01	01	H5431_012_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																												
H5431	013	0	1	01	01	H5431_013_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																												
H5431	016	0	1	01	01	H5431_016_0	6	2	01000	Non-Food Grocery Items	2	1	0.00	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	6	2	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5431	019	0	1	01	01	H5431_019_0	6	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																																																																																
H5431	021	0	1	01	01	H5431_021_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																												
H5431	022	0	1	01	01	H5431_022_0	6	1	01100	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	2	2	Non-food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																												
H5471	064	0	1	01	01	H5471_064_0	13	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	065	0	1	01	01	H5471_065_0	9	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5471	066	0	1	01	01	H5471_066_0	10	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	068	0	1	01	01	H5471_068_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	069	0	1	01	01	H5471_069_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	070	0	1	01	01	H5471_070_0	10	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	072	0	1	01	01	H5471_072_0	9	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	073	0	1	01	01	H5471_073_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	075	0	1	01	01	H5471_075_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	076	0	1	01	01	H5471_076_0	9	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	077	0	1	01	01	H5471_077_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5471	080	0	1	01	01	H5471_080_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	082	0	1	01	01	H5471_082_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	083	0	1	01	01	H5471_083_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5471	084	0	1	01	01	H5471_084_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	085	0	1	01	01	H5471_085_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	111	0	1	01	01	H5471_111_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	114	0	1	01	01	H5471_114_0	9	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5471	115	0	1	01	01	H5471_115_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	116	0	1	01	01	H5471_116_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	118	0	1	01	01	H5471_118_0	10	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	119	0	1	01	01	H5471_119_0	9	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	121	0	1	01	01	H5471_121_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	122	0	1	01	01	H5471_122_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	124	0	1	01	01	H5471_124_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5471	125	0	1	01	01	H5471_125_0	9	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5471	126	0	1	01	01	H5471_126_0	8	1	01000	Non-food grocery items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5472	001	0	1	02	01	H5472_001_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5472	002	0	1	02	01	H5472_002_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5472	003	0	1	02	01	H5472_003_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5472	004	0	1	02	01	H5472_004_0	16	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H5521	116	0	1	04	01	H5521_116_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	169	0	1	04	01	H5521_169_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	171	0	1	04	01	H5521_171_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	178	0	1	04	01	H5521_178_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	216	0	1	04	01	H5521_216_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	218	0	1	04	01	H5521_218_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	220	0	1	04	01	H5521_220_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	222	0	1	04	01	H5521_222_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	224	0	1	04	01	H5521_224_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	227	0	1	04	01	H5521_227_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	229	0	1	04	01	H5521_229_0	4	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	230	0	1	04	01	H5521_230_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	232	0	1	04	01	H5521_232_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	233	0	1	04	01	H5521_233_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	234	0	1	04	01	H5521_234_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	302	0	1	04	01	H5521_302_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	302	0	1	04	01	H5521_302_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	326	0	1	04	01	H5521_326_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	360	0	1	04	01	H5521_360_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	360	0	1	04	01	H5521_360_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	364	0	1	04	01	H5521_364_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	364	0	1	04	01	H5521_364_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	365	0	1	04	01	H5521_365_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	365	0	1	04	01	H5521_365_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	366	0	1	04	01	H5521_366_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	366	0	1	04	01	H5521_366_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	376	0	1	04	01	H5521_376_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	398	0	1	04	01	H5521_398_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	399	0	1	04	01	H5521_399_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	399	0	1	04	01	H5521_399_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	447	0	1	04	01	H5521_447_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	448	0	1	04	01	H5521_448_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	449	0	1	04	01	H5521_449_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	462	0	1	04	01	H5521_462_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	463	0	1	04	01	H5521_463_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	464	0	1	04	01	H5521_464_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	465	0	1	04	01	H5521_465_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	467	0	1	04	01	H5521_467_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	468	0	1	04	01	H5521_468_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	469	0	1	04	01	H5521_469_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	470	0	1	04	01	H5521_470_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	471	0	1	04	01	H5521_471_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	472	0	1	04	01	H5521_472_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	472	0	1	04	01	H5521_472_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	473	0	1	04	01	H5521_473_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	473	0	1	04	01	H5521_473_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	474	0	1	04	01	H5521_474_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	474	0	1	04	01	H5521_474_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	801	0	1	04	01	H5521_801_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	802	0	1	04	01	H5521_802_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	805	0	2	04	01	H5521_805_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	806	0	2	04	01	H5521_806_0	7	1	01100	At plan sponsor discretion	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	809	0	1	04	01	H5521_809_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	810	0	1	04	01	H5521_810_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	812	0	1	04	01	H5521_812_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	814	0	2	04	01	H5521_814_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	815	0	2	04	01	H5521_815_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	816	0	2	04	01	H5521_816_0	7	1	01100	At plan sponsor discretion	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	817	0	1	04	01	H5521_817_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	818	0	2	04	01	H5521_818_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	819	0	1	04	01	H5521_819_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	820	0	1	04	01	H5521_820_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	821	0	1	04	01	H5521_821_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	822	0	1	04	01	H5521_822_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	823	0	2	04	01	H5521_823_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	824	0	2	04	01	H5521_824_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	825	0	1	04	01	H5521_825_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	826	0	2	04	01	H5521_826_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	827	0	2	04	01	H5521_827_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	828	0	2	04	01	H5521_828_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	829	0	1	04	01	H5521_829_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	830	0	2	04	01	H5521_830_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	831	0	1	04	01	H5521_831_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	832	0	1	04	01	H5521_832_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	833	0	1	04	01	H5521_833_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	834	0	1	04	01	H5521_834_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	835	0	2	04	01	H5521_835_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	836	0	1	04	01	H5521_836_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5521	837	0	1	04	01	H5521_837_0	7	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	013	0	1	04	01	H5522_013_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	013	0	1	04	01	H5522_013_0	6	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	024	0	1	04	01	H5522_024_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	802	0	1	04	01	H5522_802_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	803	0	1	04	01	H5522_803_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	808	0	2	04	01	H5522_808_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	809	0	2	04	01	H5522_809_0	6	1	01100	At plan sponsor discretion	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	810	0	1	04	01	H5522_810_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	811	0	1	04	01	H5522_811_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	813	0	2	04	01	H5522_813_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	814	0	2	04	01	H5522_814_0	6	1	01100	At plan sponsor discretion	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	815	0	1	04	01	H5522_815_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	816	0	1	04	01	H5522_816_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	817	0	2	04	01	H5522_817_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	818	0	2	04	01	H5522_818_0	6	1	01100	At plan sponsor discretion	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	819	0	1	04	01	H5522_819_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	820	0	1	04	01	H5522_820_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	821	0	1	04	01	H5522_821_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	822	0	2	04	01	H5522_822_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	823	0	1	04	01	H5522_823_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	824	0	2	04	01	H5522_824_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	825	0	2	04	01	H5522_825_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	826	0	2	04	01	H5522_826_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	827	0	2	04	01	H5522_827_0	6	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	828	0	1	04	01	H5522_828_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	829	0	2	04	01	H5522_829_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	830	0	1	04	01	H5522_830_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	831	0	1	04	01	H5522_831_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	832	0	1	04	01	H5522_832_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	833	0	1	04	01	H5522_833_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	834	0	2	04	01	H5522_834_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	835	0	1	04	01	H5522_835_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5522	836	0	1	04	01	H5522_836_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H5525	036	0	1	04	01	H5525_036_0	6	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	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																																								
H5525	053	0	1	04	01	H5525_053_0	7	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	072	0	1	04	01	H5525_072_0	7	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	073	0	1	04	01	H5525_073_0	7	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 food and supplies	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 food and supplies	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	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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 food and supplies	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	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	054	1	1	01	01	H5577_054_1	4	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	054	2	1	01	01	H5577_054_2	4	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	054	3	1	01	01	H5577_054_3	4	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	055	0	1	01	01	H5577_055_0	4	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	056	1	1	01	01	H5577_056_1	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	056	2	1	01	01	H5577_056_2	5	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	057	0	1	01	01	H5577_057_0	6	1	01111	Home cleaning	2	2				2				2			2		2			2	2	Pet food and supplies	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	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5593	801	0	1	01	01	H5593_801_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5593	802	0	1	01	01	H5593_802_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5594	016	0	1	01	01	H5594_016_0	8	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5594	017	0	1	01	01	H5594_017_0	8	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5594	028	0	1	01	01	H5594_028_0	6	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5594	029	0	1	01	01	H5594_029_0	6	1	01000	Non-Food Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5594	036	0	1	01	01	H5594_036_0	6	1	01000	Non-Food Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H5619	054	0	1	02	01	H5619_054_0	5	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	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	8	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	5	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	8	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	7	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	5	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	7	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	7	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	113	0	1	02	01	H5619_113_0	5	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	126	0	1	02	01	H5619_126_0	7	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	134	0	1	01	01	H5619_134_0	7	1	01110	Pet Care Assistance	2	1	1000	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	7	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	145	0	1	01	01	H5619_145_0	8	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	275.00	7		2				2			2		2			2	2																				
H5619	152	0	1	01	01	H5619_152_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																																								
H5619	153	0	1	01	01	H5619_153_0	7	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																																								
H5619	154	0	1	01	01	H5619_154_0	5	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			1	2																				
H5619	160	0	1	01	01	H5619_160_0	7	1	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																																								
H5619	161	0	1	01	01	H5619_161_0	6	1	01000	Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2																																																																																
H5619	162	0	1	02	01	H5619_162_0	5	2	01110	Pet Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000.00	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000.00	3		2				2			2		2			1	2																																								
H5619	163	0	1	01	01	H5619_163_0	5	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	164	0	1	01	01	H5619_164_0	5	1	01000	Healthy Living Products	2	1	65.00	7		2				2			2		2			2	2																																																																																
H5628	001	0	1	01	01	H5628_001_0	4	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5628	007	0	1	01	01	H5628_007_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5628	008	0	1	01	01	H5628_008_0	4	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	5	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	4	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	4	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	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	019	0	1	02	01	H5793_019_0	9	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	019	0	1	02	01	H5793_019_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	020	0	1	02	01	H5793_020_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	801	0	1	01	01	H5793_801_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5793	802	0	1	01	01	H5793_802_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5810	014	0	1	01	01	H5810_014_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5823	006	0	1	01	01	H5823_006_0	4	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	4	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5823	012	1	1	01	01	H5823_012_1	7	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5823	012	2	1	01	01	H5823_012_2	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5926	001	0	1	01	01	H5926_001_0	4	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	4	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	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5943	001	0	1	02	01	H5943_001_0	6	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	7	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	8	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5992	009	1	1	01	01	H5992_009_1	8	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H5992	009	2	1	01	01	H5992_009_2	9	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H6399	001	0	1	01	01	H6399_001_0	6	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H6622	008	0	1	01	01	H6622_008_0	8	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
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	8	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	035	0	1	01	01	H6622_035_0	7	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	5	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	7	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	071	0	1	01	01	H6622_071_0	7	1	01000	Healthy Living Products	2	1	35.00	7		2				2			2		2			2	2																																																																																
H6622	078	1	1	01	01	H6622_078_1	8	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H6622	078	2	1	01	01	H6622_078_2	8	2	01110	Pet Care Assistance	2	1	1000	3		2				2			2		2			1	2	Travel Care Assistance	2	1	1000	3		2				2			2		2			1	2	Barber and Beauty Shop Care	2	1	1000	3		2				2			2		2			1	2																																								
H6622	084	0	1	01	01	H6622_084_0	5	1	01000	Healthy Living Products	2	1	75.00	7		2				2			2		2			2	2																																																																																
H6622	088	0	1	02	01	H6622_088_0	7	1	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																																								
H6832	002	0	1	01	01	H6832_002_0	11	1	01000	Cognitive Member Kit	2	2				2				2			2		2			2	2																																																																																
H6959	002	0	1	01	01	H6959_002_0	8	1	01000	Cleaning	2	1	0.00	5		2				2			2		2			2	2																																																																																
H7074	001	0	1	04	01	H7074_001_0	11	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H7123	001	0	1	01	01	H7123_001_0	9	3	01000	Wellness Box	2	2				2				2			2		2			2	2																																																																																
H7149	006	0	1	01	01	H7149_006_0	6	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7149	801	0	1	01	01	H7149_801_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H7149	802	0	1	01	01	H7149_802_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H7284	007	0	1	04	01	H7284_007_0	5	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H7284	008	0	1	04	01	H7284_008_0	5	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H7284	009	0	1	04	01	H7284_009_0	11	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H7284	010	0	1	04	01	H7284_010_0	6	1	01000	Foot Hygiene Services	2	2				2				2			2		2			1	2																																																																																
H7301	014	0	1	04	01	H7301_014_0	7	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7301	014	0	1	04	01	H7301_014_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7301	801	0	1	04	01	H7301_801_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H7301	803	0	1	04	01	H7301_803_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H7557	001	0	1	01	01	H7557_001_0	7	1	01000	Beauty Benefit	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	9	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	11	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H7670	001	0	1	01	01	H7670_001_0	7	1	01000	Parking	2	2				2				2			2		2			1	2																																																																																
H7670	002	0	1	01	01	H7670_002_0	6	1	01000	Parking	2	2				2				2			2		2			1	2																																																																																
H7678	001	0	1	01	01	H7678_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H7678	004	0	1	01	01	H7678_004_0	6	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	6	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	086	0	1	04	01	H7849_086_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	089	0	1	04	01	H7849_089_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	126	0	1	04	01	H7849_126_0	5	1	01000	Pet Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H8176	001	0	1	01	01	H8176_001_0	5	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H8176	003	0	1	01	01	H8176_003_0	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
H8244	002	0	1	04	01	H8244_002_0	15	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H8332	801	0	1	01	01	H8332_801_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8332	802	0	1	01	01	H8332_802_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8457	001	0	1	01	01	H8457_001_0	5	1	01000	Beauty Benefit	2	2				2				2			2		2			2	2																																																																																
H8597	001	0	1	01	01	H8597_001_0	9	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	002	0	1	01	01	H8597_002_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	002	0	1	01	01	H8597_002_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	003	0	1	01	01	H8597_003_0	8	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	003	0	1	01	01	H8597_003_0	8	2	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8649	010	0	1	01	01	H8649_010_0	7	1	01000	Pet Care & Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8649	801	0	1	01	01	H8649_801_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8649	803	0	1	01	01	H8649_803_0	5	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8845	001	0	1	01	01	H8845_001_0	4	1	01000	Service Animal Supplies	2	1	150.00	5		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																																																																																
H9147	001	0	1	02	01	H9147_001_0	7	1	01000	Non-Food Produce/Grocery Items	2	1	0.00	7		2				2			2		1	0.00	0.00	2	2																																																																																
H9414	001	0	1	04	01	H9414_001_0	10	1	00110																					Identity Theft	2	2				2				2			2		2			2	2	Sneakers	2	1	50.00	3		2				2			2		2			2	2																																								
H9414	002	0	1	04	01	H9414_002_0	11	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																																																												
H9431	801	0	1	04	01	H9431_801_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H9431	802	0	1	04	01	H9431_802_0	5	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor discretion	2	2				2				2			2		2			2	2																																																												
H9590	001	0	1	01	01	H9590_001_0	5	1	01000	Beauty Benefit	2	2				2				2			2		2			2	2																																																																																
H9614	001	0	1	04	01	H9614_001_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9686	001	0	1	01	01	H9686_001_0	12	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9686	004	0	1	01	01	H9686_004_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9686	005	0	1	01	01	H9686_005_0	13	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H9861	001	0	1	02	01	H9861_001_0	11	1	01000	Identity Theft Insurance	2	2				2				2			2		2			2	2																																																																																
H9861	003	0	1	01	01	H9861_003_0	11	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																																																												
H9876	001	0	1	04	01	H9876_001_0	9	1	01100	Sneakers	2	1	100.00	3		2				2			2		2			2	2	Identity Theft Insurance	2	2				2				2			2		2			2	2																																																												
H9876	002	0	1	04	01	H9876_002_0	9	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																																																												
H9917	002	0	1	01	01	H9917_002_0	10	1	01000	Cognitive Member Kit	2	2				2				2			2		2			2	2																																																																																
H9940	001	0	1	01	01	H9940_001_0	11	1	01000	Beauty Benefit	2	2				2				2			2		2			2	2																																																																																
H9943	001	0	1	02	01	H9943_001_0	13	1	01100	Pet Services	2	1	560.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9943	002	0	1	02	01	H9943_002_0	13	1	01100	Pet Services	2	1	560.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9943	003	0	1	01	01	H9943_003_0	14	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9943	004	0	1	01	01	H9943_004_0	15	1	01000	Pet Services	2	1	280.00	3		2				2			2		2			1	1																																																																																
H9943	005	0	1	02	01	H9943_005_0	13	1	01100	Pet Services	2	1	280.00	3		2				2			2		2			1	1	House Cleaning Services	2	2				2				2			2		1	50.00	50.00	1	1																																																												
H9955	001	0	1	01	01	H9955_001_0	5	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	6	1	01000	Service Animal Supplies	2	1	150.00	5		2				2			2		2			1	2																																																																																
