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_maxplan_per_d	pbp_b13i_o5_maxenr_yn	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	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	015	0	1	02	01	H0028_015_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	031	0	1	01	01	H0028_031_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	032	0	1	01	01	H0028_032_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	033	0	1	01	01	H0028_033_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	034	0	1	01	01	H0028_034_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	036	0	1	01	01	H0028_036_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	044	0	1	01	01	H0028_044_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	045	0	1	01	01	H0028_045_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	068	0	1	02	01	H0028_068_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	078	0	1	01	01	H0028_078_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0028	079	0	1	01	01	H0028_079_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H0439	002	0	1	01	01	H0439_002_0	6	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H0439	012	0	1	01	01	H0439_012_0	6	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H0523	074	0	1	02	01	H0523_074_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0523	076	0	1	02	01	H0523_076_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0523	078	0	1	02	01	H0523_078_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0523	080	0	1	02	01	H0523_080_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0523	801	0	1	01	01	H0523_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0523	805	0	1	01	01	H0523_805_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0628	001	0	1	02	01	H0628_001_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	005	0	1	02	01	H0628_005_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	012	0	1	01	01	H0628_012_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	013	0	1	01	01	H0628_013_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	017	0	1	02	01	H0628_017_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H0628	801	0	1	01	01	H0628_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0628	802	0	1	01	01	H0628_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H0738	001	0	1	01	01	H0738_001_0	7	1	01000	Pet Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H0982	002	0	1	01	01	H0982_002_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	007	0	1	01	01	H0982_007_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	008	0	1	01	01	H0982_008_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	009	0	1	01	01	H0982_009_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	010	0	1	01	01	H0982_010_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	012	0	1	01	01	H0982_012_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	013	0	1	01	01	H0982_013_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	016	0	1	01	01	H0982_016_0	9	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	017	0	1	01	01	H0982_017_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	018	0	1	01	01	H0982_018_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	019	0	1	01	01	H0982_019_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	020	0	1	01	01	H0982_020_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	021	0	1	01	01	H0982_021_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	022	0	1	01	01	H0982_022_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	023	0	1	01	01	H0982_023_0	6	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	024	0	1	01	01	H0982_024_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	025	0	1	01	01	H0982_025_0	6	1	01000	Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H0982	026	0	1	01	01	H0982_026_0	8	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H0982	027	0	1	01	01	H0982_027_0	7	1	01000	Pet Supplies	2	2				2				2			2		2			1	2																																																																																
H1019	001	0	1	02	01	H1019_001_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	006	0	1	01	01	H1019_006_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	023	0	1	01	01	H1019_023_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1019	073	0	1	01	01	H1019_073_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1019	098	0	1	01	01	H1019_098_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	103	1	1	01	01	H1019_103_1	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	103	2	1	01	01	H1019_103_2	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	108	0	1	01	01	H1019_108_0	8	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	113	0	1	01	01	H1019_113_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	117	0	1	01	01	H1019_117_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	124	0	1	01	01	H1019_124_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	130	0	1	01	01	H1019_130_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	146	0	1	01	01	H1019_146_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1019	147	2	1	01	01	H1019_147_2	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1019	151	2	1	01	01	H1019_151_2	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	054	0	1	01	01	H1036_054_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	062	0	1	01	01	H1036_062_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	065	0	1	01	01	H1036_065_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	077	0	1	01	01	H1036_077_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	077	0	1	01	01	H1036_077_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	102	0	1	01	01	H1036_102_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	102	0	1	01	01	H1036_102_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	167	0	1	01	01	H1036_167_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	209	0	1	01	01	H1036_209_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	209	0	1	01	01	H1036_209_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	210	0	1	01	01	H1036_210_0	8	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	210	0	1	01	01	H1036_210_0	8	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	213	0	1	01	01	H1036_213_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	213	0	1	01	01	H1036_213_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	214	0	1	01	01	H1036_214_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	214	0	1	01	01	H1036_214_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	222	0	1	01	01	H1036_222_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	226	0	1	01	01	H1036_226_0	6	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	230	0	1	01	01	H1036_230_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	233	0	1	02	01	H1036_233_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	235	0	1	01	01	H1036_235_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	280	0	1	01	01	H1036_280_0	6	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	285	0	1	01	01	H1036_285_0	8	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	285	0	1	01	01	H1036_285_0	8	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	291	0	1	02	01	H1036_291_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	301	0	1	01	01	H1036_301_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	302	0	1	01	01	H1036_302_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	304	0	1	01	01	H1036_304_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	304	0	1	01	01	H1036_304_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	307	0	1	01	01	H1036_307_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	314	0	1	01	01	H1036_314_0	8	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1036	314	0	1	01	01	H1036_314_0	8	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	315	0	1	01	01	H1036_315_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1036	316	0	1	01	01	H1036_316_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H1109	801	0	1	01	01	H1109_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1109	802	0	1	01	01	H1109_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1206	004	0	1	01	01	H1206_004_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1206	005	0	1	01	01	H1206_005_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1206	801	0	1	01	01	H1206_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1206	802	0	1	01	01	H1206_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1526	001	0	1	02	01	H1526_001_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1526	002	0	1	02	01	H1526_002_0	9	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1526	003	0	1	02	01	H1526_003_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1526	004	0	1	02	01	H1526_004_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1526	008	0	1	02	01	H1526_008_0	9	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1526	009	0	1	02	01	H1526_009_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H1587	003	0	1	02	01	H1587_003_0	9	1	01000	Memory Activity Box	2	2				2				2			2		2			2	2																																																																																
H1608	027	0	1	04	01	H1608_027_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	062	0	1	04	01	H1608_062_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	073	0	1	04	01	H1608_073_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	075	0	1	04	01	H1608_075_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	076	0	1	04	01	H1608_076_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	077	0	1	04	01	H1608_077_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	078	0	1	04	01	H1608_078_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	080	0	1	04	01	H1608_080_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	083	0	1	04	01	H1608_083_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1608	801	0	1	04	01	H1608_801_0	1	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	1	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	017	0	1	01	01	H1609_017_0	8	1	01000	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	019	0	1	01	01	H1609_019_0	8	1	01000	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	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	022	0	1	01	01	H1609_022_0	7	1	01000	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	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	035	0	1	01	01	H1609_035_0	7	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	041	0	1	01	01	H1609_041_0	7	1	01000	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	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	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	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	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	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	048	0	1	01	01	H1609_048_0	8	1	01000	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	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	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	061	0	1	01	01	H1609_061_0	7	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	062	0	1	01	01	H1609_062_0	7	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	063	0	1	01	01	H1609_063_0	7	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	064	0	1	01	01	H1609_064_0	6	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	065	0	1	01	01	H1609_065_0	6	1	01000	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	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	068	0	1	02	01	H1609_068_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1609	801	0	1	01	01	H1609_801_0	2	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H1609	807	0	1	01	01	H1609_807_0	2	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H1610	001	0	1	01	01	H1610_001_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1610	003	0	1	01	01	H1610_003_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1692	005	0	1	01	01	H1692_005_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H1692	801	0	1	01	01	H1692_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1692	802	0	1	01	01	H1692_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H1748	003	0	1	01	01	H1748_003_0	6	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	004	0	1	01	01	H1748_004_0	8	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	005	0	1	01	01	H1748_005_0	8	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	010	0	1	01	01	H1748_010_0	7	1	01000	Wheelchair Upgrades	2	1	3000.00	3		2				2			2		2			2	2																																																																																
H1748	011	0	1	01	01	H1748_011_0	6	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	012	0	1	01	01	H1748_012_0	8	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	013	0	1	01	01	H1748_013_0	6	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	014	0	1	01	01	H1748_014_0	7	1	01000	Wheelchair Upgrades	2	1	3000.00	3		2				2			2		2			2	2																																																																																
H1748	015	0	1	01	01	H1748_015_0	8	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1748	016	0	1	01	01	H1748_016_0	7	1	01000	Pet Food and Pet Supplies	2	2				2				2			2		2			2	2																																																																																
H1951	032	0	1	01	01	H1951_032_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1951	041	0	1	01	01	H1951_041_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1951	056	0	1	01	01	H1951_056_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H1951	057	0	1	01	01	H1951_057_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H2056	801	0	1	01	01	H2056_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2056	802	0	1	01	01	H2056_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2108	039	0	1	01	01	H2108_039_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H2108	041	0	1	01	01	H2108_041_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H2108	043	1	1	01	01	H2108_043_1	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H2108	043	2	1	01	01	H2108_043_2	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H2168	001	0	1	01	01	H2168_001_0	7	1	01000	Gasoline at the pump	2	1	0.00	7		2				2			2		2			2	2																																																																																
H2168	003	0	1	01	01	H2168_003_0	7	1	01000	Gasoline at the pump	2	1	0.00	7		2				2			2		2			2	2																																																																																
H2293	001	0	1	04	01	H2293_001_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	002	0	1	04	01	H2293_002_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	002	0	1	04	01	H2293_002_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	003	0	1	04	01	H2293_003_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	003	0	1	04	01	H2293_003_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	004	0	1	04	01	H2293_004_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	004	0	1	04	01	H2293_004_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	005	0	1	04	01	H2293_005_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	005	0	1	04	01	H2293_005_0	3	2	01000	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	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	011	0	1	04	01	H2293_011_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	011	0	1	04	01	H2293_011_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	021	0	1	04	01	H2293_021_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	023	0	1	04	01	H2293_023_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	023	0	1	04	01	H2293_023_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	028	0	1	04	01	H2293_028_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	029	0	1	04	01	H2293_029_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	031	0	1	04	01	H2293_031_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2293	033	0	1	04	01	H2293_033_0	3	1	01000	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																																																												
H2459	031	0	1	01	01	H2459_031_0	8	1	01000	Memory support kit	2	2				2				2			2		2			2	2																																																																																
H2459	032	0	1	01	01	H2459_032_0	9	1	01000	Memory support kit	2	2				2				2			2		2			2	2																																																																																
H2663	052	0	1	01	01	H2663_052_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	053	0	1	01	01	H2663_053_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	054	0	1	01	01	H2663_054_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	055	0	1	01	01	H2663_055_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	056	0	1	01	01	H2663_056_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	057	0	1	02	01	H2663_057_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	064	0	1	01	01	H2663_064_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	067	0	1	01	01	H2663_067_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H2663	805	0	1	01	01	H2663_805_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2663	810	0	1	01	01	H2663_810_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H2752	003	0	1	01	01	H2752_003_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H2875	001	0	1	02	01	H2875_001_0	5	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H2875	001	0	1	02	01	H2875_001_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H2875	002	0	1	02	01	H2875_002_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H2875	003	0	1	01	01	H2875_003_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H2875	004	0	1	01	01	H2875_004_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H3146	002	0	1	01	01	H3146_002_0	5	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	003	0	1	01	01	H3146_003_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	006	0	1	01	01	H3146_006_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	008	0	1	01	01	H3146_008_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	011	0	1	01	01	H3146_011_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	012	0	1	01	01	H3146_012_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	016	0	1	01	01	H3146_016_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	017	0	1	01	01	H3146_017_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	018	0	1	01	01	H3146_018_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	019	0	1	01	01	H3146_019_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	021	0	1	01	01	H3146_021_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	022	0	1	01	01	H3146_022_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	022	0	1	01	01	H3146_022_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	023	0	1	01	01	H3146_023_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	023	0	1	01	01	H3146_023_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3146	801	0	1	01	01	H3146_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3146	802	0	1	01	01	H3146_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3152	801	0	1	01	01	H3152_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3152	804	0	1	01	01	H3152_804_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3192	007	0	1	01	01	H3192_007_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3192	007	0	1	01	01	H3192_007_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3192	021	0	1	02	01	H3192_021_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3192	801	0	1	01	01	H3192_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3192	802	0	1	01	01	H3192_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3219	002	0	1	04	01	H3219_002_0	5	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3219	801	0	1	04	01	H3219_801_0	1	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	1	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	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	002	0	1	01	01	H3239_002_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	003	0	1	01	01	H3239_003_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	005	0	1	01	01	H3239_005_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	006	0	1	01	01	H3239_006_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	007	0	1	01	01	H3239_007_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	008	0	1	01	01	H3239_008_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	010	0	1	01	01	H3239_010_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	012	0	1	01	01	H3239_012_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	013	0	1	01	01	H3239_013_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	013	0	1	01	01	H3239_013_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	015	0	1	01	01	H3239_015_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	015	0	1	01	01	H3239_015_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	016	0	1	01	01	H3239_016_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	016	0	1	01	01	H3239_016_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	017	0	1	01	01	H3239_017_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	018	0	1	01	01	H3239_018_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	018	0	1	01	01	H3239_018_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	019	0	1	01	01	H3239_019_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	019	0	1	01	01	H3239_019_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	020	0	1	01	01	H3239_020_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	021	0	1	01	01	H3239_021_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	021	0	1	01	01	H3239_021_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	022	0	1	01	01	H3239_022_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	023	0	1	01	01	H3239_023_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3239	023	0	1	01	01	H3239_023_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	001	0	1	04	01	H3288_001_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	002	0	1	04	01	H3288_002_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	003	0	1	04	01	H3288_003_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	004	0	1	04	01	H3288_004_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	017	0	1	04	01	H3288_017_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	018	0	1	04	01	H3288_018_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	019	0	1	04	01	H3288_019_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	034	0	1	04	01	H3288_034_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	048	0	1	04	01	H3288_048_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	053	0	1	04	01	H3288_053_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	053	0	1	04	01	H3288_053_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3288	801	0	1	04	01	H3288_801_0	1	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	1	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	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	069	0	1	01	01	H3312_069_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	070	0	1	01	01	H3312_070_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	073	0	1	01	01	H3312_073_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	074	0	1	01	01	H3312_074_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	087	0	1	01	01	H3312_087_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	088	0	1	01	01	H3312_088_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	089	0	1	01	01	H3312_089_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	090	0	1	01	01	H3312_090_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	090	0	1	01	01	H3312_090_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3312	801	0	1	01	01	H3312_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3312	804	0	1	01	01	H3312_804_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3347	003	0	1	02	01	H3347_003_0	6	1	01000	Personal Hygeine	2	1	0.00	6	Members not eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI) will only receive Over-the-Counter Non-Prescription Drug Coverage. The combined benefit is available monthly	2				2			2		1	0.00	0.00	2	2																																																																																
H3347	018	0	1	02	01	H3347_018_0	5	1	01000	Personal Hygeine	2	1	0.00	6	Members not eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI) will only receive Over-the-Counter Non-Prescription Drug Coverage. The combined benefit is available monthly	2				2			2		1	0.00	0.00	2	2																																																																																
H3443	001	0	1	01	01	H3443_001_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3443	002	0	1	01	01	H3443_002_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3443	003	0	1	01	01	H3443_003_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3443	005	0	1	01	01	H3443_005_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3443	006	0	1	01	01	H3443_006_0	6	1	01000	Pet Services	2	2				2				2			2		2			1	1																																																																																
H3533	002	0	1	01	01	H3533_002_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H3533	034	1	1	01	01	H3533_034_1	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H3533	034	2	1	01	01	H3533_034_2	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H3597	011	0	1	02	01	H3597_011_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3597	012	0	1	02	01	H3597_012_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3597	801	0	1	01	01	H3597_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3597	802	0	1	01	01	H3597_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3748	801	0	1	01	01	H3748_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3748	802	0	1	01	01	H3748_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3815	001	0	1	01	01	H3815_001_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	007	0	1	01	01	H3815_007_0	16	1	01000	Pet Servies	2	2				2				2			2		2			2	2																																																																																
H3815	008	0	1	01	01	H3815_008_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	010	0	1	01	01	H3815_010_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	011	0	1	01	01	H3815_011_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	013	0	1	01	01	H3815_013_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	016	0	1	02	01	H3815_016_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	019	0	1	01	01	H3815_019_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	020	0	1	01	01	H3815_020_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	021	0	1	01	01	H3815_021_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	023	0	1	01	01	H3815_023_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	028	0	1	01	01	H3815_028_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	030	0	1	01	01	H3815_030_0	8	1	01000	Pet Servies	2	2				2				2			2		2			2	2																																																																																
H3815	031	0	1	01	01	H3815_031_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	033	0	1	01	01	H3815_033_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	034	0	1	01	01	H3815_034_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	035	0	1	01	01	H3815_035_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	037	0	1	01	01	H3815_037_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	038	0	1	01	01	H3815_038_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	039	0	1	01	01	H3815_039_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	040	0	1	01	01	H3815_040_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	041	0	1	01	01	H3815_041_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	042	0	1	01	01	H3815_042_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	043	0	1	01	01	H3815_043_0	11	1	01000	Pet Services	2	2				2				2			2		2			1	1																																																																																
H3815	044	0	1	01	01	H3815_044_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	045	0	1	01	01	H3815_045_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	046	0	1	01	01	H3815_046_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	047	0	1	01	01	H3815_047_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	048	0	1	01	01	H3815_048_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3815	049	0	1	01	01	H3815_049_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H3928	001	0	1	01	01	H3928_001_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3928	801	0	1	01	01	H3928_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3928	803	0	1	01	01	H3928_803_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3931	004	0	1	02	01	H3931_004_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	095	0	1	02	01	H3931_095_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	099	0	1	02	01	H3931_099_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	100	0	1	02	01	H3931_100_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	157	0	1	02	01	H3931_157_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	159	0	1	01	01	H3931_159_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	160	0	1	02	01	H3931_160_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	166	0	1	02	01	H3931_166_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	166	0	1	02	01	H3931_166_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	169	0	1	02	01	H3931_169_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	175	0	1	01	01	H3931_175_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	176	0	1	02	01	H3931_176_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	176	0	1	02	01	H3931_176_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	177	0	1	02	01	H3931_177_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	177	0	1	02	01	H3931_177_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	178	0	1	02	01	H3931_178_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3931	801	0	1	01	01	H3931_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3931	804	0	1	01	01	H3931_804_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3949	009	0	1	01	01	H3949_009_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H3959	001	0	1	02	01	H3959_001_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	002	0	1	02	01	H3959_002_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	033	0	1	02	01	H3959_033_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	033	0	1	02	01	H3959_033_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	035	0	1	01	01	H3959_035_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	035	0	1	01	01	H3959_035_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	036	0	1	01	01	H3959_036_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	036	0	1	01	01	H3959_036_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	039	0	1	02	01	H3959_039_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	052	0	1	02	01	H3959_052_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	063	0	1	01	01	H3959_063_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	069	0	1	01	01	H3959_069_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	069	0	1	01	01	H3959_069_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	070	0	1	01	01	H3959_070_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	070	0	1	01	01	H3959_070_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	071	0	1	01	01	H3959_071_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	071	0	1	01	01	H3959_071_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	072	0	1	01	01	H3959_072_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	073	0	1	01	01	H3959_073_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	073	0	1	01	01	H3959_073_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	074	0	1	01	01	H3959_074_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	075	0	1	01	01	H3959_075_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	076	0	1	01	01	H3959_076_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	077	0	1	01	01	H3959_077_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H3959	803	0	1	01	01	H3959_803_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H3959	804	0	1	01	01	H3959_804_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4003	009	0	1	01	01	H4003_009_0	9	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-HOMEMINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4003	009	0	1	01	01	H4003_009_0	9	2	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4003	017	0	1	01	01	H4003_017_0	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4003	017	0	1	01	01	H4003_017_0	8	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	9	2	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	9	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4003	034	0	1	02	01	H4003_034_0	8	1	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	034	0	1	02	01	H4003_034_0	8	2	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4003	055	0	1	02	01	H4003_055_0	8	1	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4003	058	0	1	01	01	H4003_058_0	8	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	8	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	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	056	0	1	02	01	H4004_056_0	8	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-HOMEMINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	056	0	1	02	01	H4004_056_0	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	062	0	1	01	01	H4004_062_0	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	062	0	1	01	01	H4004_062_0	8	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	8	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-HOMEMINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	063	0	1	02	01	H4004_063_0	8	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	065	0	1	02	01	H4004_065_0	9	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	065	0	1	02	01	H4004_065_0	9	2	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	066	0	1	02	01	H4004_066_0	8	1	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND OTHER	2	1	300.00	6	MAXIMUM AMOUNT OF $300 PER SERVICE FOR ROADSIDE ASSISTANCE AND IN-HOMEMINOR REPAIR SERVICES ONLY.	2				2			2		2			2	2																																																																																
H4004	066	0	1	02	01	H4004_066_0	8	2	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	068	0	1	01	01	H4004_068_0	7	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	068	0	1	01	01	H4004_068_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																																																																																
H4004	069	0	1	01	01	H4004_069_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																																																																																
H4004	069	0	1	01	01	H4004_069_0	7	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	070	0	1	02	01	H4004_070_0	7	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4004	070	0	1	02	01	H4004_070_0	7	2	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	071	0	1	02	01	H4004_071_0	6	2	01000	ROADSIDE ASSISTANCE IN-HOME MINOR REPAIRS AND 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	071	0	1	02	01	H4004_071_0	6	1	01110	PET CARE	2	2				2				2			2		2			2	2	PERSONAL CARE ITEMS	2	2				2				2			2		2			2	2	ADDITIONAL ROADSIDE/IN-HOME MINOR REPAIRS & OTHER	2	2				2				2			2		2			2	2																																								
H4007	027	0	1	01	01	H4007_027_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4007	030	0	1	01	01	H4007_030_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4007	031	0	1	01	01	H4007_031_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4141	003	0	1	01	01	H4141_003_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4141	015	0	1	01	01	H4141_015_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H4141	017	5	1	01	01	H4141_017_5	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H4141	023	0	1	01	01	H4141_023_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H4172	001	0	1	01	01	H4172_001_0	5	1	01000	Beauty and Barber Shop	2	2				2				2			2		2			2	2																																																																																
H4227	001	0	1	01	01	H4227_001_0	7	1	01000	Pet Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4227	002	0	1	01	01	H4227_002_0	6	1	01000	Pet Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4286	002	0	1	01	01	H4286_002_0	10	1	01000	Pet Care and Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4286	004	0	1	01	01	H4286_004_0	10	1	01000	Pet care and Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4286	005	0	1	01	01	H4286_005_0	9	1	01000	Pet Care and Supplies	2	2				2				2			2		2			2	2																																																																																
H4407	004	0	1	01	01	H4407_004_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4407	029	0	1	01	01	H4407_029_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4461	022	0	1	01	01	H4461_022_0	6	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4461	022	0	1	01	01	H4461_022_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H4461	038	0	1	01	01	H4461_038_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H4461	038	0	1	01	01	H4461_038_0	5	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H4513	009	0	1	01	01	H4513_009_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H4513	027	0	1	01	01	H4513_027_0	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	033	0	1	01	01	H4513_033_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H4513	034	0	1	01	01	H4513_034_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	039	0	1	01	01	H4513_039_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	055	0	1	01	01	H4513_055_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	060	1	1	01	01	H4513_060_1	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	060	2	1	01	01	H4513_060_2	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	060	3	1	01	01	H4513_060_3	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	060	4	1	01	01	H4513_060_4	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	060	5	1	01	01	H4513_060_5	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	063	0	1	01	01	H4513_063_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	075	0	1	01	01	H4513_075_0	5	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	078	0	1	01	01	H4513_078_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H4513	079	0	1	01	01	H4513_079_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	080	0	1	01	01	H4513_080_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	081	0	1	01	01	H4513_081_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H4513	082	0	1	01	01	H4513_082_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H4523	020	0	1	01	01	H4523_020_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	021	0	1	01	01	H4523_021_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	024	0	1	01	01	H4523_024_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	027	0	1	01	01	H4523_027_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	028	0	1	01	01	H4523_028_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	028	0	1	01	01	H4523_028_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	029	0	1	01	01	H4523_029_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	029	0	1	01	01	H4523_029_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	030	0	1	01	01	H4523_030_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	030	0	1	01	01	H4523_030_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4523	801	0	1	01	01	H4523_801_0	1	1	01000	Other CMS defined chronic conditions	2	2				2				2			2		2			2	1																																																																																
H4523	802	0	1	01	01	H4523_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4711	011	0	1	01	01	H4711_011_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	012	0	1	01	01	H4711_012_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	013	0	1	01	01	H4711_013_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H4711	801	0	1	01	01	H4711_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4711	802	0	1	01	01	H4711_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4739	001	0	1	01	01	H4739_001_0	6	1	01000	Pet Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H4835	801	0	1	01	01	H4835_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4835	802	0	1	01	01	H4835_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4869	001	0	1	02	01	H4869_001_0	9	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4869	002	0	1	02	01	H4869_002_0	9	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4869	003	0	1	02	01	H4869_003_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4869	004	0	1	02	01	H4869_004_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4869	011	0	1	02	01	H4869_011_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4869	013	0	1	02	01	H4869_013_0	10	1	01000	Pet Care Supplies	2	2				2				2			2		2			2	2																																																																																
H4961	001	0	1	04	01	H4961_001_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H4961	003	0	1	04	01	H4961_003_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H4961	006	0	1	04	01	H4961_006_0	12	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H4982	801	0	1	01	01	H4982_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H4982	802	0	1	01	01	H4982_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5178	002	0	1	01	01	H5178_002_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	142	2	1	04	01	H5216_142_2	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	164	0	1	04	01	H5216_164_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	205	0	1	04	01	H5216_205_0	3	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	219	0	1	04	01	H5216_219_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	220	0	1	04	01	H5216_220_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	227	0	1	04	01	H5216_227_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	228	0	1	04	01	H5216_228_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	242	0	1	04	01	H5216_242_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	243	0	1	04	01	H5216_243_0	9	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	257	0	1	04	01	H5216_257_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	267	0	1	04	01	H5216_267_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	268	0	1	04	01	H5216_268_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	277	0	1	04	01	H5216_277_0	4	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	277	0	1	04	01	H5216_277_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	292	0	1	04	01	H5216_292_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	296	0	1	04	01	H5216_296_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	298	0	1	04	01	H5216_298_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	302	0	1	04	01	H5216_302_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	317	0	1	04	01	H5216_317_0	3	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	330	0	1	04	01	H5216_330_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	331	0	1	04	01	H5216_331_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	332	0	1	04	01	H5216_332_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	347	0	1	04	01	H5216_347_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	361	0	1	04	01	H5216_361_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	362	0	1	04	01	H5216_362_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	367	0	1	04	01	H5216_367_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	369	0	1	04	01	H5216_369_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	370	0	1	04	01	H5216_370_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	377	0	1	04	01	H5216_377_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	385	0	1	04	01	H5216_385_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	388	0	1	04	01	H5216_388_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	391	0	1	04	01	H5216_391_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	394	0	1	04	01	H5216_394_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	400	0	1	04	01	H5216_400_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	401	0	1	04	01	H5216_401_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	402	0	1	04	01	H5216_402_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	413	0	1	04	01	H5216_413_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	416	0	1	04	01	H5216_416_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	418	0	1	04	01	H5216_418_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	419	0	1	04	01	H5216_419_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	420	0	1	04	01	H5216_420_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5216	444	0	1	04	01	H5216_444_0	5	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	446	0	1	04	01	H5216_446_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5216	447	0	1	04	01	H5216_447_0	6	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5296	003	0	1	02	01	H5296_003_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5296	004	0	1	02	01	H5296_004_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5296	005	0	1	02	01	H5296_005_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5296	006	0	1	01	01	H5296_006_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5296	007	0	1	01	01	H5296_007_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5296	008	0	1	01	01	H5296_008_0	9	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5302	012	0	1	01	01	H5302_012_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	012	0	1	01	01	H5302_012_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	013	0	1	01	01	H5302_013_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	014	0	1	01	01	H5302_014_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	020	0	1	01	01	H5302_020_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	022	0	1	01	01	H5302_022_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5302	809	0	1	01	01	H5302_809_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5302	810	0	1	01	01	H5302_810_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5325	001	0	1	01	01	H5325_001_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	002	0	1	01	01	H5325_002_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	003	0	1	01	01	H5325_003_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	004	0	1	01	01	H5325_004_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	005	0	1	01	01	H5325_005_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	006	0	1	01	01	H5325_006_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	007	0	1	01	01	H5325_007_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	009	0	1	01	01	H5325_009_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	010	0	1	01	01	H5325_010_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	010	0	1	01	01	H5325_010_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	011	0	1	01	01	H5325_011_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5325	011	0	1	01	01	H5325_011_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5410	013	0	1	01	01	H5410_013_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	025	0	1	01	01	H5410_025_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	031	0	1	01	01	H5410_031_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	032	0	1	01	01	H5410_032_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	042	0	1	01	01	H5410_042_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	045	0	1	01	01	H5410_045_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	046	0	1	01	01	H5410_046_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	047	0	1	01	01	H5410_047_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	049	0	1	01	01	H5410_049_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	055	0	1	01	01	H5410_055_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	056	0	1	01	01	H5410_056_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H5410	057	0	1	01	01	H5410_057_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H5410	058	0	1	01	01	H5410_058_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H5431	001	0	1	01	01	H5431_001_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	006	0	1	01	01	H5431_006_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	012	0	1	01	01	H5431_012_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	013	0	1	01	01	H5431_013_0	8	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	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	1	2																																																																																
H5431	017	0	1	01	01	H5431_017_0	7	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	018	0	1	01	01	H5431_018_0	7	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	019	0	1	01	01	H5431_019_0	8	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	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	1	2																																																																																
H5431	021	0	1	01	01	H5431_021_0	7	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5431	022	0	1	01	01	H5431_022_0	6	1	01000	Personal Hygiene Care	2	1	40.00	7		2				2			2		1	0.00	0.00	1	2																																																																																
H5472	001	0	1	02	01	H5472_001_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5472	002	0	1	02	01	H5472_002_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5472	003	0	1	02	01	H5472_003_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5472	004	0	1	02	01	H5472_004_0	7	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5472	005	0	1	02	01	H5472_005_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5472	007	0	1	02	01	H5472_007_0	7	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H5521	084	0	1	04	01	H5521_084_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	116	0	1	04	01	H5521_116_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	171	0	1	04	01	H5521_171_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	178	0	1	04	01	H5521_178_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	216	0	1	04	01	H5521_216_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	218	0	1	04	01	H5521_218_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	220	0	1	04	01	H5521_220_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	222	0	1	04	01	H5521_222_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	224	0	1	04	01	H5521_224_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	227	0	1	04	01	H5521_227_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	229	0	1	04	01	H5521_229_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	230	0	1	04	01	H5521_230_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	232	0	1	04	01	H5521_232_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	233	0	1	04	01	H5521_233_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	235	0	1	04	01	H5521_235_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	251	0	1	04	01	H5521_251_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	302	0	1	04	01	H5521_302_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	302	0	1	04	01	H5521_302_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	324	0	1	04	01	H5521_324_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	326	0	1	04	01	H5521_326_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	364	0	1	04	01	H5521_364_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	364	0	1	04	01	H5521_364_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	365	0	1	04	01	H5521_365_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	376	0	1	04	01	H5521_376_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	398	0	1	04	01	H5521_398_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	399	0	1	04	01	H5521_399_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	399	0	1	04	01	H5521_399_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	400	0	1	04	01	H5521_400_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	414	0	1	04	01	H5521_414_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	424	0	1	04	01	H5521_424_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	443	0	1	04	01	H5521_443_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	449	0	1	04	01	H5521_449_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	462	0	1	04	01	H5521_462_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	463	0	1	04	01	H5521_463_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	464	0	1	04	01	H5521_464_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	465	0	1	04	01	H5521_465_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	467	0	1	04	01	H5521_467_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	469	0	1	04	01	H5521_469_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	470	0	1	04	01	H5521_470_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	471	0	1	04	01	H5521_471_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	472	0	1	04	01	H5521_472_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	472	0	1	04	01	H5521_472_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	474	0	1	04	01	H5521_474_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	474	0	1	04	01	H5521_474_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	482	0	1	04	01	H5521_482_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	490	0	1	04	01	H5521_490_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	496	0	1	04	01	H5521_496_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	496	0	1	04	01	H5521_496_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	500	0	1	04	01	H5521_500_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	501	0	1	04	01	H5521_501_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	502	0	1	04	01	H5521_502_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	505	0	1	04	01	H5521_505_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	505	0	1	04	01	H5521_505_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	538	0	1	04	01	H5521_538_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	539	0	1	04	01	H5521_539_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	550	0	1	04	01	H5521_550_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	551	0	1	04	01	H5521_551_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	553	0	1	04	01	H5521_553_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	598	0	1	04	01	H5521_598_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	644	0	1	04	01	H5521_644_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	645	0	1	04	01	H5521_645_0	2	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	646	0	1	04	01	H5521_646_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5521	801	0	1	04	01	H5521_801_0	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	At plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5521	802	0	1	04	01	H5521_802_0	1	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	1	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	1	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	809	0	1	04	01	H5521_809_0	1	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	1	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	1	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	1	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	1	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	1	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	817	0	1	04	01	H5521_817_0	1	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	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5521	819	0	1	04	01	H5521_819_0	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5521	827	0	2	04	01	H5521_827_0	1	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	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5521	829	0	1	04	01	H5521_829_0	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5521	830	0	2	04	01	H5521_830_0	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	001	0	1	04	01	H5522_001_0	3	3	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	001	0	1	04	01	H5522_001_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	002	0	1	04	01	H5522_002_0	3	3	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	005	0	1	04	01	H5522_005_0	3	3	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	005	0	1	04	01	H5522_005_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	013	0	1	04	01	H5522_013_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	013	0	1	04	01	H5522_013_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	024	0	1	04	01	H5522_024_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	024	0	1	04	01	H5522_024_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5522	802	0	1	04	01	H5522_802_0	1	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	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5522	808	0	2	04	01	H5522_808_0	1	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	1	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	810	0	1	04	01	H5522_810_0	1	1	01100	Other CMS defined chronic conditions	2	2				2				2			2		2			2	2	at plan sponsor's discretion	2	2				2				2			2		2			2	2																																																												
H5522	811	0	1	04	01	H5522_811_0	1	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	1	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	1	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	815	0	1	04	01	H5522_815_0	1	1	01100	Other CMS defined chronic	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	1	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	1	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	1	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	819	0	1	04	01	H5522_819_0	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	1	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	4	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5525	036	0	1	04	01	H5525_036_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5525	046	0	1	04	01	H5525_046_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5525	050	0	1	04	01	H5525_050_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5525	072	0	1	04	01	H5525_072_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5525	083	0	1	04	01	H5525_083_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5577	002	0	1	01	01	H5577_002_0	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	4	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	4	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	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	5	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	2	1	0.00	7		2				2			2		2			2	2	Hairstyling	2	2				2				2			2		2			2	2																				
H5577	059	0	1	01	01	H5577_059_0	8	2	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	2	1	0.00	7		2				2			2		2			2	2	Hairstyling	2	2				2				2			2		2			2	2																				
H5577	059	0	1	01	01	H5577_059_0	8	1	00111																					Pet food and supplies	2	1	0.00	7		2				2			2		2			2	2	Memory and Cognitive Function Support	2	1	0.00	7		2				2			2		2			2	2	Hairstyling	2	2				2				2			2		2			2	2																				
H5593	001	0	1	01	01	H5593_001_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5593	801	0	1	01	01	H5593_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5593	802	0	1	01	01	H5593_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5619	003	0	1	01	01	H5619_003_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	038	0	1	01	01	H5619_038_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	054	0	1	02	01	H5619_054_0	7	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5619	054	0	1	02	01	H5619_054_0	7	2	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	075	0	1	01	01	H5619_075_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	082	0	1	01	01	H5619_082_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	093	0	1	01	01	H5619_093_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	123	0	1	02	01	H5619_123_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	126	0	1	02	01	H5619_126_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	135	0	1	01	01	H5619_135_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5619	155	0	1	01	01	H5619_155_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	156	0	1	02	01	H5619_156_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	157	0	1	01	01	H5619_157_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5619	158	0	1	02	01	H5619_158_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	162	0	1	02	01	H5619_162_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	163	0	1	01	01	H5619_163_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	165	0	1	01	01	H5619_165_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	166	0	1	01	01	H5619_166_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	167	0	1	01	01	H5619_167_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	168	0	1	01	01	H5619_168_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H5619	173	0	1	01	01	H5619_173_0	3	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H5793	017	0	1	02	01	H5793_017_0	5	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	019	0	1	02	01	H5793_019_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	020	0	1	02	01	H5793_020_0	5	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H5793	801	0	1	01	01	H5793_801_0	2	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5793	802	0	1	01	01	H5793_802_0	2	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H5937	001	0	1	01	01	H5937_001_0	5	1	01000	Stress Reduction Kit	2	2				2				2			2		2			2	2																																																																																
H5969	002	0	1	01	01	H5969_002_0	4	2	01000	General Supports for Living (Rent)	2	1	70.00	7		2				2			2		2			2	2																																																																																
H5969	003	0	1	01	01	H5969_003_0	4	2	01000	General Supports for Living (Rent)	2	1	70.00	7		2				2			2		2			2	2																																																																																
H5970	020	0	1	04	01	H5970_020_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6378	001	0	1	01	01	H6378_001_0	7	1	01000	Pet Supplies	2	1	0.00	7		2				2			2		2			2	2																																																																																
H6396	005	0	1	01	01	H6396_005_0	5	1	01100	Personal Care Items	2	1	0.00	7		2				2			2		2			2	2	Pet Care Items	2	1	0.00	7		2				2			2		2			2	2																																																												
H6399	001	0	1	01	01	H6399_001_0	2	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	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	015	0	1	01	01	H6622_015_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	018	0	1	01	01	H6622_018_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	027	0	1	02	01	H6622_027_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	048	0	1	01	01	H6622_048_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	061	0	1	02	01	H6622_061_0	4	1	01100	Pet Care Assistance	2	2				2				2			2		2			1	2	Barber and Beauty Shop Care	2	2				2				2			2		2			1	2																																																												
H6622	078	1	1	01	01	H6622_078_1	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	078	2	1	01	01	H6622_078_2	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	079	0	1	01	01	H6622_079_0	5	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	086	0	1	01	01	H6622_086_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H6622	087	0	1	01	01	H6622_087_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H7074	001	0	1	04	01	H7074_001_0	8	1	01000	Pet Services	2	2				2				2			2		2			1	1																																																																																
H7149	006	0	1	01	01	H7149_006_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7149	008	0	1	02	01	H7149_008_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7149	801	0	1	01	01	H7149_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H7149	802	0	1	01	01	H7149_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H7284	010	0	1	04	01	H7284_010_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H7301	009	0	1	04	01	H7301_009_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7301	022	0	1	04	01	H7301_022_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7301	022	0	1	04	01	H7301_022_0	3	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H7301	801	0	1	04	01	H7301_801_0	1	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	1	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																																																												
H7389	009	0	1	01	01	H7389_009_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H7389	010	0	1	01	01	H7389_010_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H7787	002	0	1	04	01	H7787_002_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	086	0	1	04	01	H7849_086_0	3	1	01000	Pet Care Assistance	2	1	75.00	3		2				2			2		2			2	2																																																																																
H7849	089	0	1	04	01	H7849_089_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	126	0	1	04	01	H7849_126_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	138	0	1	04	01	H7849_138_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H7849	139	0	1	04	01	H7849_139_0	3	1	01000	Pet Care Assistance	2	1	75.00	5		2				2			2		2			2	2																																																																																
H8145	069	0	1	09	04	H8145_069_0	3	1	01100	Pet Care Assistance	2	2				2				2			2		2					Barber and Beauty Shop Care	2	2				2				2			2		2																																																																
H8330	001	0	1	01	01	H8330_001_0	5	1	01000	Bathroom Safety & Indoor Air Quality	2	2				2				2			2		2			2	2																																																																																
H8330	002	0	1	01	01	H8330_002_0	5	1	01000	Bathroom Safety & Indoor Air Quality	2	2				2				2			2		2			2	2																																																																																
H8332	801	0	1	01	01	H8332_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8332	802	0	1	01	01	H8332_802_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8390	015	0	1	01	01	H8390_015_0	4	1	01100	Personal Care Items	2	1	0.00	7		2				2			2		2			2	2	Pet Care Items	2	1	0.00	7		2				2			2		2			2	2																																																												
H8597	001	0	1	01	01	H8597_001_0	5	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	001	0	1	01	01	H8597_001_0	5	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	002	0	1	01	01	H8597_002_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	002	0	1	01	01	H8597_002_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	003	0	1	01	01	H8597_003_0	4	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8597	003	0	1	01	01	H8597_003_0	4	2	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8649	010	0	1	01	01	H8649_010_0	3	1	01000	Personal Care Items	2	2				2				2			2		1	0.00	0.00	2	2																																																																																
H8649	801	0	1	01	01	H8649_801_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8649	803	0	1	01	01	H8649_803_0	1	1	01000	At plan sponsor discretion	2	2				2				2			2		2			2	1																																																																																
H8832	001	0	1	04	01	H8832_001_0	11	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H8832	002	0	1	04	01	H8832_002_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H8832	003	0	1	04	01	H8832_003_0	10	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H8908	005	0	1	01	01	H8908_005_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H8908	007	0	1	01	01	H8908_007_0	4	1	01000	Healthy Living and Aging Support	2	2				2				2			2		2			2	2																																																																																
H9066	002	0	1	01	01	H9066_002_0	6	1	01000	Beauty/Barber Shop	2	2				2				2			2		2			2	2																																																																																
H9431	801	0	1	04	01	H9431_801_0	1	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	1	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																																																												
H9686	004	0	1	01	01	H9686_004_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H9686	005	0	1	01	01	H9686_005_0	8	1	01000	Pet Services	2	2				2				2			2		2			2	2																																																																																
H9725	003	0	1	01	01	H9725_003_0	4	1	01000	Home and Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H9725	013	0	1	01	01	H9725_013_0	4	1	01000	Home Cleaning Supplies	2	2				2				2			2		2			2	2																																																																																
H9917	001	0	1	01	01	H9917_001_0	8	1	01000	Beauty and Barber Shop	2	2				2				2			2		2			2	2																																																																																
H9917	004	0	1	01	01	H9917_004_0	7	1	01000	Beauty and Barber Shop	2	2				2				2			2		2			2	2																																																																																
H9917	005	0	1	01	01	H9917_005_0	7	1	01000	Beauty and Barber Shop	2	2				2				2			2		2			2	2																																																																																
