pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	part_d_model_demo	part_d_enhncd_cvrg_demo	mrx_form_model_type	mrx_drug_ben_yn	mrx_benefit_type	mrx_partd_network_loc	mrx_ltc_attest_flag	mrx_first_fill	mrx_otc_meds_pay_ump_yn	mrx_otc_meds_attest_flag	mrx_formulary_tiers_num	mrx_tier_form_ex	mrx_tier_form_ex_2_yn	mrx_tier_form_ex_2	mrx_ae_oon_cstshr_struct	mrx_ae_cstshr_apply	mrx_form_model_desc	mrx_ae_ooptcs_apply	mrx_alt_ded_charge	mrx_alt_ded_amount	mrx_alt_ded_type_yn	mrx_alt_no_ded_tier	mrx_alt_ded_tier_cstshr_yn	mrx_alt_gen_cstshr_struct	mrx_alt_gen_coins_pct	mrx_alt_gen_copay_amt	mrx_alt_oon_cstshr_struct	mrx_alt_red_cost_sharing	mrx_alt_red_cost_sharing_items	mrx_alt_fulfill_desc	mrx_alt_excl_drugs_yn	mrx_alt_pre_icl_cost_share	mrx_alt_pre_icl_exclud_only_yn	mrx_alt_ira_covg_tier	mrx_alt_cstshr_post_oopt	mrx_gen_loc_rstd	mrx_gen_rstd_1m	mrx_gen_rstd_2m	mrx_gen_rstd_3m	mrx_gen_loc_oon	mrx_gen_oon_1m	mrx_gen_oon_os	mrx_gen_loc_mostd	mrx_gen_mostd_1m	mrx_gen_mostd_2m	mrx_gen_mostd_3m	mrx_gen_loc_ltc	mrx_gen_ltc_1m	mrx_tier_extd_days_gen_yn	mrx_gen_extd_first_fill	mrx_gen_ira_rstd_copay_1m	mrx_gen_ira_rstd_copay_2m	mrx_gen_ira_rstd_copay_3m	mrx_gen_ira_mostd_copay_1m	mrx_gen_ira_mostd_copay_2m	mrx_gen_ira_mostd_copay_3m	mrx_gen_ira_oonp_copay_1m	mrx_gen_ira_oonp_copay_othnum	mrx_gen_ira_ltcp_copay_1m	mrx_gen_ira_rstd_coins_1m	mrx_gen_ira_rstd_coins_2m	mrx_gen_ira_rstd_coins_3m	mrx_gen_ira_mostd_coins_1m	mrx_gen_ira_mostd_coins_2m	mrx_gen_ira_mostd_coins_3m	mrx_gen_ira_oonp_coins_1m	mrx_gen_ira_oonp_coins_othnum	mrx_gen_ira_ltcp_coins_1m	mrx_avg_exp_cost_share_attest	mrx_snp_zerocost_attest	mrx_vaccine_attest	mrx_insulin_attest
H0016	001	0	1	20	08	H0016_001_0	2				1																																																																				
H0016	003	0	1	20	08	H0016_003_0	2				1																																																																				
H0028	007	0	1	01	01	H0028_007_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H0028	014	0	1	01	01	H0028_014_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	015	0	1	02	01	H0028_015_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H0028	016	0	1	02	01	H0028_016_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	017	0	1	01	01	H0028_017_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	019	0	1	01	01	H0028_019_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	021	0	1	01	01	H0028_021_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	024	0	1	01	01	H0028_024_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	028	0	1	01	01	H0028_028_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	029	0	1	01	01	H0028_029_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	030	0	1	01	01	H0028_030_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	032	0	1	01	01	H0028_032_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H0028	035	0	1	01	01	H0028_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	036	0	1	01	01	H0028_036_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H0028	037	0	1	01	01	H0028_037_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	039	0	1	01	01	H0028_039_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H0028	041	0	1	01	01	H0028_041_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	042	0	1	01	01	H0028_042_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	043	1	1	01	01	H0028_043_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	043	2	1	01	01	H0028_043_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	046	0	1	01	01	H0028_046_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	051	0	1	01	01	H0028_051_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	053	1	1	01	01	H0028_053_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	053	3	1	01	01	H0028_053_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	054	1	1	02	01	H0028_054_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	054	2	1	02	01	H0028_054_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	055	0	1	02	01	H0028_055_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	056	0	1	02	01	H0028_056_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	059	0	1	01	01	H0028_059_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	060	0	1	01	01	H0028_060_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H0028	062	0	1	01	01	H0028_062_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	063	0	1	01	01	H0028_063_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	065	0	1	01	01	H0028_065_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	066	0	1	02	01	H0028_066_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	067	0	1	02	01	H0028_067_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	070	0	1	01	01	H0028_070_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	072	0	1	01	01	H0028_072_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0028	074	1	1	01	01	H0028_074_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	074	2	1	01	01	H0028_074_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	076	0	1	01	01	H0028_076_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	140.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	077	0	1	01	01	H0028_077_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	305.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H0028	078	0	1	01	01	H0028_078_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H0028	079	0	1	01	01	H0028_079_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	360.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H0028	080	0	1	01	01	H0028_080_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H0028	081	1	1	01	01	H0028_081_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	081	2	1	01	01	H0028_081_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	082	0	1	01	01	H0028_082_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H0028	801	0	1	01	01	H0028_801_0	4				1																																																																				
H0028	802	0	1	01	01	H0028_802_0	3	N	N		2																																																																				
H0028	804	0	1	01	01	H0028_804_0	3				1																																																																				
H0028	805	0	1	01	01	H0028_805_0	3	N	N		2																																																																				
H0029	007	0	1	02	01	H0029_007_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0029	008	0	1	02	01	H0029_008_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H0029	009	0	1	02	01	H0029_009_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0029	010	0	1	02	01	H0029_010_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H0029	011	0	1	02	01	H0029_011_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0034	001	0	1	01	01	H0034_001_0	8		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	1	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0034	002	0	1	01	01	H0034_002_0	11		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	1	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0062	011	0	1	01	01	H0062_011_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0062	012	0	1	01	01	H0062_012_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0074	001	0	1	04	01	H0074_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0074	004	0	1	04	01	H0074_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0104	012	0	1	04	01	H0104_012_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0111000	1				2	1	111	The $615 deductible has been reduced to $200 and only applies to Tiers 4 and 5. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tiers 2 and 3. Tiers 4 and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H0104	014	0	1	04	01	H0104_014_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The $370 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tiers 2 and 3. Tiers 4 and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H0104	015	0	1	04	01	H0104_015_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The $615 deductible has been eliminated on all tiers. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tiers 2 and 3. Tiers 4 and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H0104	016	0	1	04	01	H0104_016_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The $325 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tier 2. Tiers 3, 4, and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H0104	801	0	1	04	01	H0104_801_0	1	N	N		2																																																																				
H0104	802	0	1	04	01	H0104_802_0	1				1																																																																				
H0104	804	0	1	04	01	H0104_804_0	1				1																																																																				
H0104	805	0	1	04	01	H0104_805_0	1				1																																																																				
H0104	806	0	1	04	01	H0104_806_0	1				1																																																																				
H0104	807	0	1	04	01	H0104_807_0	1				1																																																																				
H0104	808	0	1	04	01	H0104_808_0	1				1																																																																				
H0104	809	0	1	04	01	H0104_809_0	1				1																																																																				
H0105	001	0	1	20	08	H0105_001_0	2				1																																																																				
H0105	002	0	1	20	08	H0105_002_0	2				1																																																																				
H0107	003	0	1	04	01	H0107_003_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H0107	004	0	1	04	01	H0107_004_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H0107	005	0	1	04	01	H0107_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H0107	007	0	1	04	01	H0107_007_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H0107	010	0	1	04	01	H0107_010_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H0107	011	0	1	04	01	H0107_011_0	5	N	N		2																																																																				
H0107	801	0	1	04	01	H0107_801_0	2				1																																																																				
H0107	802	0	1	04	01	H0107_802_0	2				1																																																																				
H0107	803	0	1	04	01	H0107_803_0	2	N	N		2																																																																				
H0107	804	0	1	04	01	H0107_804_0	2	N	N		2																																																																				
H0107	805	0	1	04	01	H0107_805_0	2				1																																																																				
H0107	806	0	1	04	01	H0107_806_0	2				1																																																																				
H0107	807	0	1	04	01	H0107_807_0	2				1																																																																				
H0107	808	0	1	04	01	H0107_808_0	2	N	N		2																																																																				
H0107	809	0	1	04	01	H0107_809_0	2	N	N		2																																																																				
H0107	810	0	1	04	01	H0107_810_0	2	N	N		2																																																																				
H0107	811	0	1	04	01	H0107_811_0	2	N	N		2																																																																				
H0107	812	0	1	04	01	H0107_812_0	2	N	N		2																																																																				
H0107	813	0	1	04	01	H0107_813_0	2	N	N		2																																																																				
H0107	814	0	1	04	01	H0107_814_0	2				1																																																																				
H0107	815	0	1	04	01	H0107_815_0	2				1																																																																				
H0107	816	0	1	04	01	H0107_816_0	2				1																																																																				
H0107	817	0	1	04	01	H0107_817_0	2				1																																																																				
H0107	818	0	1	04	01	H0107_818_0	2				1																																																																				
H0107	819	0	1	04	01	H0107_819_0	2				1																																																																				
H0107	820	0	1	04	01	H0107_820_0	2				1																																																																				
H0107	821	0	1	04	01	H0107_821_0	2				1																																																																				
H0111	001	0	1	04	01	H0111_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0111	004	0	1	04	01	H0111_004_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0111	007	0	1	04	01	H0111_007_0	7	N	N		2																																																																				
H0112	001	0	1	20	08	H0112_001_0	2				1																																																																				
H0112	002	0	1	20	08	H0112_002_0	2				1																																																																				
H0154	008	0	1	01	01	H0154_008_0	2	N	N		2																																																																				
H0154	011	0	1	01	01	H0154_011_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan does not charge a Part D deductible for tiers 1-2 and the actuarial value of plan cost sharing below the MOOP is less than 25%.	2	3		0111110	1																																		1		1	1
H0154	012	0	1	01	01	H0154_012_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H0154	015	1	1	01	01	H0154_015_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	This plan does not charge a Part D deductible for tiers 1-2 and the actuarial value of plan cost sharing below the MOOP is less than 25%.	2	3		0111110	1																																		1		1	1
H0154	015	2	1	01	01	H0154_015_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	This plan does not charge a Part D deductible for tiers 1-2 and the actuarial value of plan cost sharing below the MOOP is less than 25%.	2	3		0111110	1																																		1		1	1
H0154	017	0	1	01	01	H0154_017_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	This plan does not charge a Part D deductible for tiers 1-2 and the actuarial value of plan cost sharing below the MOOP is less than 25%.	2	3		0111110	1																																		1		1	1
H0154	019	0	1	01	01	H0154_019_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H0154	020	0	1	01	01	H0154_020_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	This plan does not charge a Part D deductible for tiers 1-2 and the actuarial value of plan cost sharing below the MOOP is less than 25%.	2	3		0111110	1																																		1		1	1
H0154	801	0	1	01	01	H0154_801_0	2				1																																																																				
H0154	802	0	1	01	01	H0154_802_0	2	N	N		2																																																																				
H0154	803	0	1	01	01	H0154_803_0	2				1																																																																				
H0169	001	0	1	02	01	H0169_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	002	0	1	02	01	H0169_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	003	0	1	02	01	H0169_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	004	0	1	02	01	H0169_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	006	0	1	02	01	H0169_006_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	008	0	1	02	01	H0169_008_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	009	0	1	02	01	H0169_009_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0169	010	0	1	02	01	H0169_010_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0174	004	0	1	01	01	H0174_004_0	6		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	545.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0174	006	0	1	01	01	H0174_006_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	520.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0174	009	0	1	01	01	H0174_009_0	7			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H0174	010	0	1	01	01	H0174_010_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	014	0	1	01	01	H0174_014_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	015	0	1	01	01	H0174_015_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	016	0	1	01	01	H0174_016_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	017	0	1	01	01	H0174_017_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	018	0	1	01	01	H0174_018_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	019	0	1	01	01	H0174_019_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	020	0	1	01	01	H0174_020_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	021	0	1	01	01	H0174_021_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0174	022	0	1	01	01	H0174_022_0	6		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H0174	023	0	1	01	01	H0174_023_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0174	024	0	1	01	01	H0174_024_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0174	025	0	1	01	01	H0174_025_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	580.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0174	026	0	1	01	01	H0174_026_0	6		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0216	001	0	1	20	08	H0216_001_0	2				1																																																																				
H0216	002	0	1	20	08	H0216_002_0	2				1																																																																				
H0235	001	0	1	20	08	H0235_001_0	2				1																																																																				
H0235	002	0	1	20	08	H0235_002_0	2				1																																																																				
H0251	002	0	1	02	01	H0251_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0251	004	0	1	02	01	H0251_004_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0251	008	0	1	02	01	H0251_008_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0270	001	0	1	04	01	H0270_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0292	001	0	1	01	01	H0292_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0292	002	0	1	01	01	H0292_002_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0292	003	0	1	01	01	H0292_003_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0294	002	0	1	04	01	H0294_002_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	004	0	1	04	01	H0294_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	014	0	1	04	01	H0294_014_0	3	N	N		2																																																																				
H0294	015	0	1	04	01	H0294_015_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	016	0	1	04	01	H0294_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	017	0	1	04	01	H0294_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	018	0	1	04	01	H0294_018_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	022	0	1	04	01	H0294_022_0	3	N	N		2																																																																				
H0294	027	0	1	04	01	H0294_027_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0294	032	0	1	04	01	H0294_032_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0294	048	0	1	04	01	H0294_048_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0294	049	0	1	04	01	H0294_049_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0294	050	0	1	04	01	H0294_050_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0294	051	0	1	04	01	H0294_051_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0302	001	0	1	01	01	H0302_001_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	385.00	2	0110001	1				2	1	011		2	3		0111111	1																																				1	1
H0302	006	0	1	01	01	H0302_006_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	385.00	2	0110001	1				2	1	011		2	3		0111111	1																																				1	1
H0302	008	0	1	01	01	H0302_008_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	385.00	2	0110001	1				2	1	011		2	3		0111111	1																																				1	1
H0302	801	0	1	01	01	H0302_801_0	1	N	N		2																																																																				
H0321	002	0	1	02	01	H0321_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0321	004	0	1	02	01	H0321_004_0	5		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0332	001	0	1	01	01	H0332_001_0	5	N	N		2																																																																				
H0332	004	0	1	02	01	H0332_004_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	Plan charges lesser deductible and reduces cost sharing for drugs in the ICL phase. We do not charge the Medicare Part D defined standard deductible.	1	3		0111111	3																																		1		1	1
H0332	009	0	1	01	01	H0332_009_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Plan charges lesser deductible and reduces cost sharing for drugs in the ICL phase. We do not charge the Medicare Part D defined standard deductible.	1	3		0111111	3																																		1		1	1
H0332	801	0	1	01	01	H0332_801_0	4	N	N		2																																																																				
H0332	803	0	1	01	01	H0332_803_0	4				1																																																																				
H0332	804	0	1	01	01	H0332_804_0	4	N	N		2																																																																				
H0332	805	0	1	01	01	H0332_805_0	4				1																																																																				
H0332	806	0	1	01	01	H0332_806_0	4	N	N		2																																																																				
H0332	807	0	1	01	01	H0332_807_0	4				1																																																																				
H0332	808	0	1	01	01	H0332_808_0	4	N	N		2																																																																				
H0332	809	0	1	01	01	H0332_809_0	4				1																																																																				
H0332	810	0	1	01	01	H0332_810_0	4				1																																																																				
H0332	811	0	1	01	01	H0332_811_0	4				1																																																																				
H0332	812	0	1	01	01	H0332_812_0	4				1																																																																				
H0332	813	0	1	01	01	H0332_813_0	4				1																																																																				
H0332	814	0	1	01	01	H0332_814_0	4	N	N		2																																																																				
H0342	001	0	1	04	01	H0342_001_0	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	550.00	2	0110001	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H0342	801	0	1	04	01	H0342_801_0	2				1																																																																				
H0342	802	0	1	04	01	H0342_802_0	2				1																																																																				
H0342	803	0	1	04	01	H0342_803_0	2	N	N		2																																																																				
H0342	804	0	1	04	01	H0342_804_0	2	N	N		2																																																																				
H0351	038	0	1	01	01	H0351_038_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001101	1																																		1		1	1
H0351	053	0	1	01	01	H0351_053_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	054	0	1	01	01	H0351_054_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	057	0	1	01	01	H0351_057_0	5			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001101	1																																		1		1	1
H0351	063	0	1	01	01	H0351_063_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	064	0	1	01	01	H0351_064_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	065	0	1	01	01	H0351_065_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	066	0	1	02	01	H0351_066_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0351	067	0	1	02	01	H0351_067_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0351	068	0	1	02	01	H0351_068_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0351	069	0	1	02	01	H0351_069_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001101	1																																		1		1	1
H0351	070	0	1	02	01	H0351_070_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0354	001	0	1	01	01	H0354_001_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0354	027	0	1	01	01	H0354_027_0	4			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H0354	028	0	1	01	01	H0354_028_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0354	029	0	1	01	01	H0354_029_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0354	030	0	1	01	01	H0354_030_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0354	804	0	1	01	01	H0354_804_0	1				1																																																																				
H0354	805	0	1	01	01	H0354_805_0	1				1																																																																				
H0363	001	0	1	01	01	H0363_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H0390	001	0	1	20	08	H0390_001_0	2				1																																																																				
H0390	002	0	1	20	08	H0390_002_0	2				1																																																																				
H0413	001	0	1	04	01	H0413_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H0413	002	0	1	04	01	H0413_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H0413	003	0	1	04	01	H0413_003_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H0421	001	0	1	04	01	H0421_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0423	001	0	1	01	01	H0423_001_0	7		N	5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan fulfills the requirement of increasing the actuarial value of defined standard prescription drug coverage by offering reduced copays and waiving the Part D deductible for Tiers 1 and 2.	2	3		0011110	1																																		1	1	1	1
H0423	004	0	1	01	01	H0423_004_0	7				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0423	007	0	1	01	01	H0423_007_0	7		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0424	001	0	1	20	08	H0424_001_0	2				1																																																																				
H0424	002	0	1	20	08	H0424_002_0	2				1																																																																				
H0432	003	0	1	02	01	H0432_003_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0432	004	0	1	02	01	H0432_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0432	009	0	1	02	01	H0432_009_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0432	012	0	1	02	01	H0432_012_0	3	N	N		2																																																																				
H0432	013	0	1	02	01	H0432_013_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0432	017	0	1	02	01	H0432_017_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0439	002	0	1	01	01	H0439_002_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0439	003	1	1	01	01	H0439_003_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	003	2	1	01	01	H0439_003_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	006	0	1	01	01	H0439_006_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	008	0	1	01	01	H0439_008_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	009	0	1	01	01	H0439_009_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	010	0	1	01	01	H0439_010_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	011	0	1	01	01	H0439_011_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	012	0	1	01	01	H0439_012_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0439	013	0	1	01	01	H0439_013_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	015	1	1	01	01	H0439_015_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	015	2	1	01	01	H0439_015_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	016	0	1	01	01	H0439_016_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	017	0	1	01	01	H0439_017_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	018	0	1	01	01	H0439_018_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	019	0	1	01	01	H0439_019_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	020	0	1	01	01	H0439_020_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	021	0	1	01	01	H0439_021_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	022	0	1	01	01	H0439_022_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0439	023	0	1	01	01	H0439_023_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0439	024	0	1	02	01	H0439_024_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0439	801	0	1	01	01	H0439_801_0	1				1																																																																				
H0440	001	0	1	20	08	H0440_001_0	2				1																																																																				
H0440	002	0	1	20	08	H0440_002_0	2				1																																																																				
H0473	003	0	1	04	01	H0473_003_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0473	004	0	1	04	01	H0473_004_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0473	005	0	1	04	01	H0473_005_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0477	001	0	1	20	08	H0477_001_0	2				1																																																																				
H0477	002	0	1	20	08	H0477_002_0	2				1																																																																				
H0504	015	0	1	01	01	H0504_015_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	017	0	1	01	01	H0504_017_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	021	0	1	01	01	H0504_021_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	026	0	1	01	01	H0504_026_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	028	0	1	01	01	H0504_028_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	038	0	1	01	01	H0504_038_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	039	0	1	01	01	H0504_039_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	1	3		0001100	3																																		1		1	1
H0504	040	0	1	01	01	H0504_040_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	1	3		0001100	3																																		1		1	1
H0504	041	0	1	01	01	H0504_041_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	043	0	1	01	01	H0504_043_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	1	3		0001100	3																																		1		1	1
H0504	047	0	1	01	01	H0504_047_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	050	0	1	01	01	H0504_050_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H0504	803	0	1	01	01	H0504_803_0	3				1																																																																				
H0504	804	0	1	01	01	H0504_804_0	3				1																																																																				
H0504	805	0	1	01	01	H0504_805_0	3	N	N		2																																																																				
H0504	806	0	1	01	01	H0504_806_0	3	N	N		2																																																																				
H0523	022	0	1	01	01	H0523_022_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	065	0	1	01	01	H0523_065_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	070	0	1	02	01	H0523_070_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	073	0	1	02	01	H0523_073_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	074	0	1	02	01	H0523_074_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	075	0	1	02	01	H0523_075_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	083	0	1	02	01	H0523_083_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	085	0	1	02	01	H0523_085_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	086	0	1	01	01	H0523_086_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	088	0	1	02	01	H0523_088_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	089	0	1	01	01	H0523_089_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	091	0	1	01	01	H0523_091_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	092	0	1	01	01	H0523_092_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0523	801	0	1	01	01	H0523_801_0	1	N	N		2																																																																				
H0523	805	0	1	01	01	H0523_805_0	1				1																																																																				
H0524	003	0	1	01	01	H0524_003_0	4			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	008	0	1	01	01	H0524_008_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	013	0	1	01	01	H0524_013_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	015	0	1	01	01	H0524_015_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	031	0	1	01	01	H0524_031_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	032	0	1	01	01	H0524_032_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	033	0	1	01	01	H0524_033_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	034	0	1	01	01	H0524_034_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	035	0	1	01	01	H0524_035_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	036	0	1	01	01	H0524_036_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	037	0	1	01	01	H0524_037_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	038	0	1	01	01	H0524_038_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	039	0	1	01	01	H0524_039_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	040	0	1	01	01	H0524_040_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	041	0	1	01	01	H0524_041_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	042	0	1	01	01	H0524_042_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	043	0	1	01	01	H0524_043_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	046	0	1	01	01	H0524_046_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	051	0	1	01	01	H0524_051_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	054	0	1	01	01	H0524_054_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	059	0	1	01	01	H0524_059_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	060	0	1	01	01	H0524_060_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	061	0	1	01	01	H0524_061_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	062	0	1	01	01	H0524_062_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	063	0	1	01	01	H0524_063_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	064	0	1	01	01	H0524_064_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	065	0	1	01	01	H0524_065_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	078	0	1	01	01	H0524_078_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	081	0	1	01	01	H0524_081_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	082	0	1	01	01	H0524_082_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	083	0	1	01	01	H0524_083_0	5			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0524	801	0	1	01	01	H0524_801_0	2	N	N		2																																																																				
H0524	802	0	1	01	01	H0524_802_0	2	N	N		2																																																																				
H0524	803	0	2	01	01	H0524_803_0	2	N	N		2																																																																				
H0524	804	0	2	01	01	H0524_804_0	2	N	N		2																																																																				
H0524	805	0	1	01	01	H0524_805_0	2				1																																																																				
H0524	806	0	1	01	01	H0524_806_0	2				1																																																																				
H0524	807	0	2	01	01	H0524_807_0	2				1																																																																				
H0524	808	0	2	01	01	H0524_808_0	2				1																																																																				
H0542	001	0	1	20	08	H0542_001_0	2				1																																																																				
H0542	002	0	1	20	08	H0542_002_0	2				1																																																																				
H0543	013	0	1	02	01	H0543_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	019	0	1	02	01	H0543_019_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	035	0	1	02	01	H0543_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	060	0	1	02	01	H0543_060_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	086	0	1	02	01	H0543_086_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	121	0	1	02	01	H0543_121_0	3	N	N		2																																																																				
H0543	140	0	1	02	01	H0543_140_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	145	0	1	02	01	H0543_145_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	151	0	1	02	01	H0543_151_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	152	0	1	02	01	H0543_152_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	166	0	1	02	01	H0543_166_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	168	0	1	02	01	H0543_168_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	169	0	1	02	01	H0543_169_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	170	0	1	02	01	H0543_170_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	188	0	1	02	01	H0543_188_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	189	0	1	02	01	H0543_189_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	191	0	1	02	01	H0543_191_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	193	0	1	02	01	H0543_193_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	204	0	1	02	01	H0543_204_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	214	0	1	02	01	H0543_214_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	217	0	1	02	01	H0543_217_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	218	0	1	02	01	H0543_218_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	219	0	1	02	01	H0543_219_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	220	0	1	02	01	H0543_220_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	221	0	1	02	01	H0543_221_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	222	0	1	02	01	H0543_222_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	225	0	1	02	01	H0543_225_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	226	0	1	02	01	H0543_226_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	232	0	1	02	01	H0543_232_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	236	0	1	02	01	H0543_236_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	237	0	1	02	01	H0543_237_0	10			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	238	0	1	02	01	H0543_238_0	10			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	239	0	1	01	01	H0543_239_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	240	0	1	01	01	H0543_240_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	241	0	1	01	01	H0543_241_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	242	0	1	01	01	H0543_242_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	246	0	1	01	01	H0543_246_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	249	0	1	02	01	H0543_249_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0543	251	0	1	02	01	H0543_251_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	254	0	1	02	01	H0543_254_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	255	0	1	02	01	H0543_255_0	13			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0543	258	0	1	02	01	H0543_258_0	3	N	N		2																																																																				
H0543	802	0	1	01	01	H0543_802_0	1	N	N		2																																																																				
H0543	805	0	1	01	01	H0543_805_0	1				1																																																																				
H0543	806	0	1	01	01	H0543_806_0	1				1																																																																				
H0543	810	0	1	01	01	H0543_810_0	2	N	N		2																																																																				
H0544	002	0	1	02	01	H0544_002_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	85.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	004	0	1	02	01	H0544_004_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	005	0	1	01	01	H0544_005_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001101	1																																		1		1	1
H0544	010	0	1	02	01	H0544_010_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	014	0	1	02	01	H0544_014_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	015	0	1	02	01	H0544_015_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	019	0	1	02	01	H0544_019_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	020	0	1	02	01	H0544_020_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H0544	056	0	1	02	01	H0544_056_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	058	0	1	02	01	H0544_058_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H0544	061	0	1	02	01	H0544_061_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	255.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	062	0	1	02	01	H0544_062_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	063	0	1	02	01	H0544_063_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	210.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	064	0	1	02	01	H0544_064_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	140.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	065	0	1	02	01	H0544_065_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	066	0	1	02	01	H0544_066_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H0544	069	0	1	02	01	H0544_069_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	160.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H0544	091	0	1	02	01	H0544_091_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	095	0	1	02	01	H0544_095_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	096	0	1	02	01	H0544_096_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	098	0	1	02	01	H0544_098_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H0544	108	0	1	02	01	H0544_108_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H0544	805	0	1	01	01	H0544_805_0	5				1																																																																				
H0544	806	0	1	01	01	H0544_806_0	3	N	N		2																																																																				
H0544	808	0	2	01	01	H0544_808_0	5				1																																																																				
H0544	809	0	2	01	01	H0544_809_0	5	N	N		2																																																																				
H0544	810	0	1	01	01	H0544_810_0	3	N	N		2																																																																				
H0544	812	0	2	01	01	H0544_812_0	3	N	N		2																																																																				
H0562	012	0	1	01	01	H0562_012_0	11			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	092	0	1	01	01	H0562_092_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001101	1																																		1		1	1
H0562	097	0	1	01	01	H0562_097_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	125	0	1	01	01	H0562_125_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	126	0	1	01	01	H0562_126_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	133	0	1	01	01	H0562_133_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	136	0	1	01	01	H0562_136_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	137	0	1	01	01	H0562_137_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0562	138	0	1	01	01	H0562_138_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001101	1																																		1		1	1
H0562	801	0	1	01	01	H0562_801_0	3				1																																																																				
H0562	803	0	1	01	01	H0562_803_0	3	N	N		2																																																																				
H0562	804	0	1	01	01	H0562_804_0	3				1																																																																				
H0571	001	0	1	01	01	H0571_001_0	9			5F	1	4	101110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Reduced Deductible, Reduced pre-ICL cost shares	2	3		0011100	1																																				1	1
H0571	005	0	1	01	01	H0571_005_0	9		N	5F	1	4	110110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	Reduced pre-ICL cost shares; Deductible does not apply to tier 1	2	3		0011100	1																																		1	1	1	1
H0571	007	0	1	01	01	H0571_007_0	10			5F	1	4	101110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Reduced deductible; Reduced pre-ICL cost shares	2	3		0011100	1																																				1	1
H0571	010	0	1	01	01	H0571_010_0	9			5F	1	4	101110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Reduced Deductible, Reduced pre-ICL cost shares	2	3		0011100	1																																				1	1
H0571	011	0	1	01	01	H0571_011_0	10			5F	1	4	101110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Reduced deductible; Reduced pre-ICL cost shares	2	3		0011100	1																																				1	1
H0609	007	0	1	02	01	H0609_007_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	012	0	1	02	01	H0609_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	018	0	1	02	01	H0609_018_0	3	N	N		2																																																																				
H0609	025	0	1	02	01	H0609_025_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	026	0	1	02	01	H0609_026_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	027	0	1	02	01	H0609_027_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	028	0	1	02	01	H0609_028_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	031	0	1	02	01	H0609_031_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	032	0	1	02	01	H0609_032_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	033	0	1	02	01	H0609_033_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	034	1	1	02	01	H0609_034_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	034	2	1	02	01	H0609_034_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	036	1	1	02	01	H0609_036_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	036	2	1	02	01	H0609_036_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	037	0	1	02	01	H0609_037_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	038	0	1	02	01	H0609_038_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	040	0	1	02	01	H0609_040_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	041	0	1	02	01	H0609_041_0	3	N	N		2																																																																				
H0609	042	0	1	02	01	H0609_042_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	043	0	1	02	01	H0609_043_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	044	0	1	02	01	H0609_044_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	045	0	1	02	01	H0609_045_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	046	0	1	02	01	H0609_046_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	047	0	1	02	01	H0609_047_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	048	0	1	02	01	H0609_048_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	049	0	1	02	01	H0609_049_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	050	0	1	02	01	H0609_050_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	051	0	1	02	01	H0609_051_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	052	0	1	02	01	H0609_052_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	137.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H0609	054	0	1	02	01	H0609_054_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	055	0	1	02	01	H0609_055_0	3	N	N		2																																																																				
H0609	056	0	1	02	01	H0609_056_0	3	N	N		2																																																																				
H0609	058	0	1	02	01	H0609_058_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	059	0	1	02	01	H0609_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	060	0	1	02	01	H0609_060_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	061	0	1	02	01	H0609_061_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	062	0	1	02	01	H0609_062_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	063	0	1	02	01	H0609_063_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	065	0	1	02	01	H0609_065_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	22.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H0609	066	0	1	02	01	H0609_066_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	067	0	1	02	01	H0609_067_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	068	0	1	02	01	H0609_068_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	070	0	1	02	01	H0609_070_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	071	0	1	02	01	H0609_071_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	072	0	1	02	01	H0609_072_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	073	0	1	02	01	H0609_073_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	075	0	1	02	01	H0609_075_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	076	0	1	02	01	H0609_076_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	510.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1		1	1
H0609	077	0	1	02	01	H0609_077_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	078	0	1	02	01	H0609_078_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	079	0	1	02	01	H0609_079_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	080	0	1	02	01	H0609_080_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0609	801	0	1	01	01	H0609_801_0	1	N	N		2																																																																				
H0609	804	0	1	01	01	H0609_804_0	1				1																																																																				
H0609	805	0	1	01	01	H0609_805_0	1				1																																																																				
H0609	806	0	2	01	01	H0609_806_0	1				1																																																																				
H0609	807	0	1	01	01	H0609_807_0	1	N	N		2																																																																				
H0609	808	0	1	01	01	H0609_808_0	1				1																																																																				
H0609	809	0	1	01	01	H0609_809_0	1				1																																																																				
H0609	810	0	1	01	01	H0609_810_0	1	N	N		2																																																																				
H0609	811	0	1	01	01	H0609_811_0	1				1																																																																				
H0609	812	0	1	01	01	H0609_812_0	1				1																																																																				
H0609	813	0	1	01	01	H0609_813_0	1				1																																																																				
H0609	814	0	1	01	01	H0609_814_0	1	N	N		2																																																																				
H0609	815	0	1	01	01	H0609_815_0	1				1																																																																				
H0609	817	0	1	01	01	H0609_817_0	1				1																																																																				
H0609	822	0	1	01	01	H0609_822_0	1				1																																																																				
H0609	823	0	1	01	01	H0609_823_0	1	N	N		2																																																																				
H0609	824	0	1	01	01	H0609_824_0	1				1																																																																				
H0613	001	0	1	20	08	H0613_001_0	2				1																																																																				
H0613	003	0	1	20	08	H0613_003_0	2				1																																																																				
H0624	001	0	1	02	01	H0624_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0624	006	0	1	02	01	H0624_006_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0628	001	0	1	02	01	H0628_001_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	003	0	1	02	01	H0628_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	005	0	1	02	01	H0628_005_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	007	0	1	02	01	H0628_007_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	008	0	1	02	01	H0628_008_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	010	0	1	02	01	H0628_010_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	012	0	1	01	01	H0628_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H0628	013	0	1	01	01	H0628_013_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H0628	017	0	1	02	01	H0628_017_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	018	0	1	01	01	H0628_018_0	5				1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H0628	019	0	1	02	01	H0628_019_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	021	0	1	02	01	H0628_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	024	0	1	02	01	H0628_024_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	027	0	1	02	01	H0628_027_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	031	0	1	01	01	H0628_031_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	032	0	1	01	01	H0628_032_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	033	0	1	01	01	H0628_033_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	034	0	1	01	01	H0628_034_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	035	0	1	01	01	H0628_035_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	036	0	1	01	01	H0628_036_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	037	0	1	01	01	H0628_037_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	038	0	1	01	01	H0628_038_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	039	0	1	01	01	H0628_039_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H0628	040	0	1	01	01	H0628_040_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H0628	041	0	1	01	01	H0628_041_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H0628	801	0	1	01	01	H0628_801_0	2	N	N		2																																																																				
H0629	001	0	1	01	01	H0629_001_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0629	002	0	1	01	01	H0629_002_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0629	003	0	1	01	01	H0629_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0629	004	0	1	01	01	H0629_004_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0630	013	0	1	01	01	H0630_013_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	014	0	1	01	01	H0630_014_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H0630	015	0	1	02	01	H0630_015_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	016	0	1	02	01	H0630_016_0	6			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	017	0	1	01	01	H0630_017_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	020	0	1	01	01	H0630_020_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	021	0	1	02	01	H0630_021_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	023	0	1	02	01	H0630_023_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	024	0	1	01	01	H0630_024_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0100001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H0630	025	0	1	02	01	H0630_025_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H0630	027	0	1	01	01	H0630_027_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H0630	805	0	2	01	01	H0630_805_0	1				1																																																																				
H0630	806	0	2	01	01	H0630_806_0	1	N	N		2																																																																				
H0630	807	0	1	01	01	H0630_807_0	1				1																																																																				
H0630	808	0	1	01	01	H0630_808_0	1	N	N		2																																																																				
H0630	811	0	2	01	01	H0630_811_0	1				1																																																																				
H0630	812	0	2	01	01	H0630_812_0	1	N	N		2																																																																				
H0630	813	0	1	01	01	H0630_813_0	1				1																																																																				
H0630	814	0	1	01	01	H0630_814_0	1	N	N		2																																																																				
H0630	817	0	2	01	01	H0630_817_0	1				1																																																																				
H0630	818	0	2	01	01	H0630_818_0	1	N	N		2																																																																				
H0630	819	0	1	01	01	H0630_819_0	1				1																																																																				
H0630	820	0	1	01	01	H0630_820_0	1	N	N		2																																																																				
H0672	005	0	1	01	01	H0672_005_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	006	0	1	01	01	H0672_006_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	009	0	1	01	01	H0672_009_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0672	010	0	1	01	01	H0672_010_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0672	013	0	1	01	01	H0672_013_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	015	0	1	01	01	H0672_015_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0672	016	0	1	01	01	H0672_016_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	017	0	1	01	01	H0672_017_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	018	0	1	01	01	H0672_018_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H0672	024	0	1	01	01	H0672_024_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H0672	801	0	1	01	01	H0672_801_0	1				1																																																																				
H0710	004	0	1	04	01	H0710_004_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	005	0	1	04	01	H0710_005_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	007	0	1	04	01	H0710_007_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	010	0	1	04	01	H0710_010_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	013	0	1	04	01	H0710_013_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	016	0	1	04	01	H0710_016_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	017	0	1	04	01	H0710_017_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	020	0	1	04	01	H0710_020_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	026	0	1	04	01	H0710_026_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	027	0	1	04	01	H0710_027_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	030	0	1	04	01	H0710_030_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0710	031	0	1	04	01	H0710_031_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	032	0	1	04	01	H0710_032_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	033	0	1	04	01	H0710_033_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	034	0	1	04	01	H0710_034_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	035	0	1	04	01	H0710_035_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	036	0	1	04	01	H0710_036_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	037	0	1	04	01	H0710_037_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0710	038	0	1	04	01	H0710_038_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	039	0	1	04	01	H0710_039_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	051	0	1	04	01	H0710_051_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	052	0	1	04	01	H0710_052_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	053	0	1	04	01	H0710_053_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H0710	057	0	1	04	01	H0710_057_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0710	801	0	1	04	01	H0710_801_0	1				1																																																																				
H0710	802	0	1	04	01	H0710_802_0	1	N	N		2																																																																				
H0710	803	0	1	04	01	H0710_803_0	1				1																																																																				
H0710	804	0	2	04	01	H0710_804_0	1				1																																																																				
H0710	805	0	2	04	01	H0710_805_0	1	N	N		2																																																																				
H0710	806	0	2	04	01	H0710_806_0	1				1																																																																				
H0710	807	0	1	04	01	H0710_807_0	1				1																																																																				
H0710	808	0	1	04	01	H0710_808_0	1				1																																																																				
H0710	809	0	1	04	01	H0710_809_0	1				1																																																																				
H0710	810	0	1	04	01	H0710_810_0	1	N	N		2																																																																				
H0710	811	0	1	04	01	H0710_811_0	1				1																																																																				
H0710	812	0	2	04	01	H0710_812_0	1				1																																																																				
H0710	813	0	2	04	01	H0710_813_0	1	N	N		2																																																																				
H0710	814	0	2	04	01	H0710_814_0	1				1																																																																				
H0710	815	0	1	04	01	H0710_815_0	1				1																																																																				
H0710	816	0	1	04	01	H0710_816_0	1				1																																																																				
H0710	817	0	1	04	01	H0710_817_0	1	N	N		2																																																																				
H0710	818	0	1	04	01	H0710_818_0	1				1																																																																				
H0710	819	0	1	04	01	H0710_819_0	1				1																																																																				
H0710	820	0	1	04	01	H0710_820_0	1				1																																																																				
H0710	821	0	1	04	01	H0710_821_0	1				1																																																																				
H0710	822	0	1	04	01	H0710_822_0	1				1																																																																				
H0710	823	0	1	04	01	H0710_823_0	1				1																																																																				
H0710	824	0	2	04	01	H0710_824_0	1				1																																																																				
H0710	825	0	1	04	01	H0710_825_0	1	N	N		2																																																																				
H0710	826	0	1	04	01	H0710_826_0	1				1																																																																				
H0710	827	0	1	04	01	H0710_827_0	1				1																																																																				
H0710	829	0	1	04	01	H0710_829_0	1				1																																																																				
H0710	830	0	1	04	01	H0710_830_0	1				1																																																																				
H0710	831	0	1	04	01	H0710_831_0	1				1																																																																				
H0712	005	0	1	02	01	H0712_005_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	550.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0712	019	0	1	02	01	H0712_019_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0712	029	0	1	01	01	H0712_029_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	515.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0712	032	0	1	02	01	H0712_032_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0724	801	0	1	01	01	H0724_801_0	3				1																																																																				
H0738	001	0	1	01	01	H0738_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H0738	002	0	1	01	01	H0738_002_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H0755	030	0	1	02	01	H0755_030_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	031	0	1	02	01	H0755_031_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	032	0	1	02	01	H0755_032_0	3	N	N		2																																																																				
H0755	033	0	1	02	01	H0755_033_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	037	0	1	02	01	H0755_037_0	3	N	N		2																																																																				
H0755	038	0	1	02	01	H0755_038_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	044	0	1	02	01	H0755_044_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	045	0	1	02	01	H0755_045_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	046	0	1	02	01	H0755_046_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H0755	810	0	1	01	01	H0755_810_0	1				1																																																																				
H0755	811	0	1	01	01	H0755_811_0	1	N	N		2																																																																				
H0755	812	0	1	01	01	H0755_812_0	1				1																																																																				
H0755	813	0	1	01	01	H0755_813_0	1				1																																																																				
H0755	814	0	1	01	01	H0755_814_0	1	N	N		2																																																																				
H0755	815	0	1	01	01	H0755_815_0	1				1																																																																				
H0764	001	0	1	04	01	H0764_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H0777	001	0	1	01	01	H0777_001_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	1	2	35.00	70.00	105.00	35.00	70.00	70.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H0783	004	0	1	01	01	H0783_004_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H0809	001	0	1	20	08	H0809_001_0	3				1																																																																				
H0809	002	0	1	20	08	H0809_002_0	3				1																																																																				
H0816	001	0	1	02	01	H0816_001_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H0816	002	0	1	02	01	H0816_002_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H0819	001	0	1	20	08	H0819_001_0	2				1																																																																				
H0819	002	0	1	20	08	H0819_002_0	2				1																																																																				
H0839	001	0	1	20	08	H0839_001_0	2				1																																																																				
H0839	002	0	1	20	08	H0839_002_0	2				1																																																																				
H0870	001	0	1	20	08	H0870_001_0	2				1																																																																				
H0870	002	0	1	20	08	H0870_002_0	2				1																																																																				
H0885	001	0	1	04	01	H0885_001_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	002	0	1	04	01	H0885_002_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	003	0	1	04	01	H0885_003_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	005	0	1	04	01	H0885_005_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	006	0	1	04	01	H0885_006_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	007	0	1	04	01	H0885_007_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	008	0	1	04	01	H0885_008_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0100001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	009	0	1	04	01	H0885_009_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	011		1	3		0111100	1																																		1		1	1
H0885	010	0	1	04	01	H0885_010_0	4	N	N		2																																																																				
H0885	011	0	1	04	01	H0885_011_0	4	N	N		2																																																																				
H0885	801	0	1	04	01	H0885_801_0	1	N	N		2																																																																				
H0885	802	0	1	04	01	H0885_802_0	1				1																																																																				
H0885	805	0	1	04	01	H0885_805_0	1	N	N		2																																																																				
H0885	806	0	1	04	01	H0885_806_0	1	N	N		2																																																																				
H0885	807	0	1	04	01	H0885_807_0	1	N	N		2																																																																				
H0885	808	0	1	04	01	H0885_808_0	1	N	N		2																																																																				
H0885	809	0	1	04	01	H0885_809_0	1	N	N		2																																																																				
H0885	810	0	1	04	01	H0885_810_0	1				1																																																																				
H0907	001	0	1	02	01	H0907_001_0	4		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0907	003	0	1	02	01	H0907_003_0	4		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H0908	001	0	1	02	01	H0908_001_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0908	003	0	1	02	01	H0908_003_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0908	004	0	1	02	01	H0908_004_0	10			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H0908	006	0	1	02	01	H0908_006_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0908	007	0	1	02	01	H0908_007_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0908	008	0	1	02	01	H0908_008_0	14		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0913	002	0	1	02	01	H0913_002_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0913	013	0	1	01	01	H0913_013_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H0913	015	0	1	02	01	H0913_015_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H0913	020	0	1	02	01	H0913_020_0	8	N	N		2																																																																				
H0913	021	0	1	02	01	H0913_021_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0913	022	0	1	02	01	H0913_022_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H0934	001	0	1	20	08	H0934_001_0	2				1																																																																				
H0934	002	0	1	20	08	H0934_002_0	2				1																																																																				
H0963	001	0	1	01	01	H0963_001_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	45.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H0976	001	0	1	01	01	H0976_001_0	10		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1	1	1	1
H0976	002	0	1	01	01	H0976_002_0	9		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1	1	1	1
H0978	001	0	1	01	01	H0978_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H0978	002	0	1	01	01	H0978_002_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H0978	010	0	1	01	01	H0978_010_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H0978	011	0	1	01	01	H0978_011_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H0978	802	0	1	01	01	H0978_802_0	4				1																																																																				
H0978	803	0	1	01	01	H0978_803_0	4				1																																																																				
H0978	804	0	1	01	01	H0978_804_0	4	N	N		2																																																																				
H0978	805	0	1	01	01	H0978_805_0	4	N	N		2																																																																				
H0982	002	0	1	01	01	H0982_002_0	13		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	007	0	1	01	01	H0982_007_0	12			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	008	0	1	01	01	H0982_008_0	10			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	009	0	1	01	01	H0982_009_0	10			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	010	0	1	01	01	H0982_010_0	10		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	012	0	1	01	01	H0982_012_0	10		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	013	0	1	01	01	H0982_013_0	10		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	016	0	1	01	01	H0982_016_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	017	0	1	01	01	H0982_017_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	018	0	1	01	01	H0982_018_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	019	0	1	01	01	H0982_019_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	020	0	1	01	01	H0982_020_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	021	0	1	01	01	H0982_021_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	022	0	1	01	01	H0982_022_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	023	0	1	01	01	H0982_023_0	10		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	024	0	1	01	01	H0982_024_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	025	0	1	01	01	H0982_025_0	10		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	Zero-dollar cost sharing on select tiers and coverage includes excluded drugs.	1	3		0001100	1																																		1	1	1	1
H0982	026	0	1	01	01	H0982_026_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	027	0	1	01	01	H0982_027_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																		1		1	1
H0982	028	0	1	01	01	H0982_028_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	030	0	1	01	01	H0982_030_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	031	0	1	01	01	H0982_031_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	032	0	1	01	01	H0982_032_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H0982	033	0	1	01	01	H0982_033_0	9			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	The deductible has been reduced to zero, cost shares have been lowered on a tier-by-tier basis, and coverage includes excluded drugs.	1	3		0001100	1																																				1	1
H1019	001	0	1	02	01	H1019_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	006	0	1	01	01	H1019_006_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	023	0	1	01	01	H1019_023_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H1019	043	0	1	02	01	H1019_043_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	057	0	1	02	01	H1019_057_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	065	0	1	01	01	H1019_065_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	073	0	1	01	01	H1019_073_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H1019	094	0	1	01	01	H1019_094_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	103	1	1	01	01	H1019_103_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	103	2	1	01	01	H1019_103_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	104	1	1	01	01	H1019_104_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	104	2	1	01	01	H1019_104_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	109	0	1	01	01	H1019_109_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	113	0	1	01	01	H1019_113_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	118	0	1	01	01	H1019_118_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	121	0	1	01	01	H1019_121_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	123	0	1	01	01	H1019_123_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	124	0	1	02	01	H1019_124_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	130	0	1	02	01	H1019_130_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	132	0	1	01	01	H1019_132_0	4	N	N		2																																																																				
H1019	134	0	1	01	01	H1019_134_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	135	0	1	02	01	H1019_135_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	136	0	1	01	01	H1019_136_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	138	0	1	01	01	H1019_138_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	139	0	1	01	01	H1019_139_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	144	0	1	01	01	H1019_144_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	146	0	1	01	01	H1019_146_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H1019	147	1	1	01	01	H1019_147_1	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	147	2	1	01	01	H1019_147_2	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	148	0	1	01	01	H1019_148_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	149	0	1	01	01	H1019_149_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1019	150	0	1	01	01	H1019_150_0	6			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	151	1	1	01	01	H1019_151_1	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	151	2	1	01	01	H1019_151_2	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1019	152	0	1	01	01	H1019_152_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H1019	153	0	1	01	01	H1019_153_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H1019	154	0	1	01	01	H1019_154_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1032	193	0	1	01	01	H1032_193_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	194	0	1	01	01	H1032_194_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	195	0	1	01	01	H1032_195_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	196	0	1	01	01	H1032_196_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	198	0	1	01	01	H1032_198_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	199	0	1	01	01	H1032_199_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	200	0	1	01	01	H1032_200_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	201	0	1	01	01	H1032_201_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	202	0	1	01	01	H1032_202_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	204	0	1	01	01	H1032_204_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	205	0	1	01	01	H1032_205_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	210	0	1	01	01	H1032_210_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	211	0	1	01	01	H1032_211_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	212	0	1	01	01	H1032_212_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	213	0	1	01	01	H1032_213_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	237	0	1	01	01	H1032_237_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1032	239	0	1	01	01	H1032_239_0	7	N	N		2																																																																				
H1032	240	0	1	01	01	H1032_240_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	241	0	1	01	01	H1032_241_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	242	0	1	01	01	H1032_242_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	243	0	1	01	01	H1032_243_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H1032	244	1	1	01	01	H1032_244_1	10		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	244	2	1	01	01	H1032_244_2	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	245	1	1	01	01	H1032_245_1	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1032	245	2	1	01	01	H1032_245_2	10		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1035	002	0	1	02	01	H1035_002_0	5			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	The use of copays instead of coinsurances.	2	3		0111110	1																																		1		1	1
H1035	017	0	1	01	01	H1035_017_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	019	0	1	01	01	H1035_019_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	020	0	1	01	01	H1035_020_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	021	0	1	01	01	H1035_021_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	022	0	1	01	01	H1035_022_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	025	0	1	01	01	H1035_025_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	026	0	1	01	01	H1035_026_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	033	0	1	01	01	H1035_033_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	034	0	1	01	01	H1035_034_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	040	0	1	01	01	H1035_040_0	5			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	The deductible does not apply to all tiers and the use of copays instead of coinsurances.	2	3		0111110	1																																		1		1	1
H1035	043	0	1	01	01	H1035_043_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	045	0	1	01	01	H1035_045_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	048	0	1	01	01	H1035_048_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	052	0	1	01	01	H1035_052_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H1035	801	0	1	01	01	H1035_801_0	2				1																																																																				
H1035	802	0	1	01	01	H1035_802_0	2				1																																																																				
H1035	803	0	1	01	01	H1035_803_0	2	N	N		2																																																																				
H1035	804	0	1	01	01	H1035_804_0	2	N	N		2																																																																				
H1036	025	0	1	01	01	H1036_025_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	044	0	1	01	01	H1036_044_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	054	0	1	01	01	H1036_054_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																				1	1
H1036	062	0	1	01	01	H1036_062_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	065	0	1	01	01	H1036_065_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	068	0	1	01	01	H1036_068_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	074	0	1	01	01	H1036_074_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	077	0	1	01	01	H1036_077_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	102	0	1	01	01	H1036_102_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	119	0	1	01	01	H1036_119_0	3	N	N		2																																																																				
H1036	121	0	1	01	01	H1036_121_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	137	0	1	02	01	H1036_137_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	143	0	1	01	01	H1036_143_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	146	0	1	01	01	H1036_146_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	151	0	1	01	01	H1036_151_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	153	0	1	01	01	H1036_153_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	157	0	1	01	01	H1036_157_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	167	0	1	01	01	H1036_167_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	209	0	1	01	01	H1036_209_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	210	0	1	01	01	H1036_210_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	213	0	1	01	01	H1036_213_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	320.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	214	0	1	01	01	H1036_214_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	305.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	217	0	1	01	01	H1036_217_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	222	0	1	01	01	H1036_222_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	226	0	1	01	01	H1036_226_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	229	0	1	01	01	H1036_229_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	230	0	1	01	01	H1036_230_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	233	0	1	02	01	H1036_233_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	234	0	1	01	01	H1036_234_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H1036	235	0	1	01	01	H1036_235_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	310.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	236	0	1	01	01	H1036_236_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	265	1	1	01	01	H1036_265_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	265	2	1	01	01	H1036_265_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	266	0	1	01	01	H1036_266_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	269	0	1	01	01	H1036_269_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	270	0	1	01	01	H1036_270_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	271	0	1	01	01	H1036_271_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	278	0	1	01	01	H1036_278_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	279	0	1	01	01	H1036_279_0	2	N	N		2																																																																				
H1036	280	0	1	01	01	H1036_280_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	20.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	285	0	1	01	01	H1036_285_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	530.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	286	0	1	01	01	H1036_286_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	290	0	1	01	01	H1036_290_0	2	N	N		2																																																																				
H1036	292	0	1	01	01	H1036_292_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	297	0	1	01	01	H1036_297_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	298	0	1	01	01	H1036_298_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	299	0	1	01	01	H1036_299_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	300	0	1	01	01	H1036_300_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	301	0	1	01	01	H1036_301_0	3			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	302	0	1	01	01	H1036_302_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	304	0	1	01	01	H1036_304_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	305	0	1	01	01	H1036_305_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	306	0	1	01	01	H1036_306_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	307	0	1	01	01	H1036_307_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	308	0	1	01	01	H1036_308_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	310	0	1	01	01	H1036_310_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	311	0	1	01	01	H1036_311_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	312	0	1	01	01	H1036_312_0	6			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	313	0	1	01	01	H1036_313_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	314	0	1	01	01	H1036_314_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	315	0	1	01	01	H1036_315_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	316	0	1	01	01	H1036_316_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	317	0	1	01	01	H1036_317_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H1036	318	0	1	02	01	H1036_318_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	319	0	1	01	01	H1036_319_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	320	0	1	01	01	H1036_320_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	321	0	1	01	01	H1036_321_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	322	0	1	01	01	H1036_322_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	323	0	1	01	01	H1036_323_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	324	0	1	01	01	H1036_324_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	325	0	1	01	01	H1036_325_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	326	0	1	01	01	H1036_326_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	327	0	1	01	01	H1036_327_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	328	0	1	01	01	H1036_328_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	329	0	1	01	01	H1036_329_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	330	0	1	01	01	H1036_330_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H1036	331	0	1	01	01	H1036_331_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	332	0	1	01	01	H1036_332_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1036	333	0	1	01	01	H1036_333_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	334	0	1	01	01	H1036_334_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	335	1	1	02	01	H1036_335_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	335	2	1	02	01	H1036_335_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1036	336	0	1	01	01	H1036_336_0	3			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	337	0	1	01	01	H1036_337_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	338	0	1	01	01	H1036_338_0	3			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1036	339	0	1	01	01	H1036_339_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	340	0	1	01	01	H1036_340_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	341	0	1	01	01	H1036_341_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1036	801	0	1	01	01	H1036_801_0	1				1																																																																				
H1036	806	0	1	01	01	H1036_806_0	2	N	N		2																																																																				
H1036	810	0	1	01	01	H1036_810_0	2				1																																																																				
H1036	811	0	1	01	01	H1036_811_0	2	N	N		2																																																																				
H1036	814	0	1	01	01	H1036_814_0	1				1																																																																				
H1036	815	0	1	01	01	H1036_815_0	1	N	N		2																																																																				
H1036	816	0	1	01	01	H1036_816_0	2				1																																																																				
H1036	817	0	1	01	01	H1036_817_0	2	N	N		2																																																																				
H1036	818	0	1	01	01	H1036_818_0	1				1																																																																				
H1036	819	0	1	01	01	H1036_819_0	1	N	N		2																																																																				
H1036	820	0	1	01	01	H1036_820_0	1				1																																																																				
H1036	821	0	1	01	01	H1036_821_0	1	N	N		2																																																																				
H1036	822	0	1	01	01	H1036_822_0	1				1																																																																				
H1036	823	0	1	01	01	H1036_823_0	1	N	N		2																																																																				
H1036	824	0	1	01	01	H1036_824_0	1				1																																																																				
H1036	825	0	1	01	01	H1036_825_0	1	N	N		2																																																																				
H1036	826	0	1	01	01	H1036_826_0	1				1																																																																				
H1036	827	0	1	01	01	H1036_827_0	1	N	N		2																																																																				
H1036	828	0	1	01	01	H1036_828_0	1				1																																																																				
H1036	829	0	1	01	01	H1036_829_0	1	N	N		2																																																																				
H1036	832	0	1	01	01	H1036_832_0	2				1																																																																				
H1036	833	0	1	01	01	H1036_833_0	1	N	N		2																																																																				
H1043	001	0	1	20	08	H1043_001_0	2				1																																																																				
H1043	002	0	1	20	08	H1043_002_0	2				1																																																																				
H1045	001	0	1	01	01	H1045_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Members have no deductible, Members pay copays instead of coinsurance on tiers 1, 2, and 3, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	005	0	1	01	01	H1045_005_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	012	0	1	01	01	H1045_012_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	018	0	1	01	01	H1045_018_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Members have no deductible, Members pay copays instead of coinsurance on tiers 1, 2, and 3, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	025	0	1	02	01	H1045_025_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	026	0	1	02	01	H1045_026_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	028	0	1	02	01	H1045_028_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	030	0	1	02	01	H1045_030_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	031	0	1	02	01	H1045_031_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	033	0	1	02	01	H1045_033_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	034	0	1	02	01	H1045_034_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	036	0	1	02	01	H1045_036_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	037	0	1	01	01	H1045_037_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	038	0	1	01	01	H1045_038_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	039	0	1	02	01	H1045_039_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	442.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H1045	041	0	1	02	01	H1045_041_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	042	0	1	02	01	H1045_042_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	043	0	1	02	01	H1045_043_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	045	0	1	02	01	H1045_045_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	048	1	1	02	01	H1045_048_1	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	048	2	1	02	01	H1045_048_2	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	048	3	1	02	01	H1045_048_3	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	048	4	1	02	01	H1045_048_4	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	055	0	1	02	01	H1045_055_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	056	0	1	02	01	H1045_056_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	057	0	1	02	01	H1045_057_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	058	0	1	02	01	H1045_058_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	059	0	1	02	01	H1045_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	060	0	1	02	01	H1045_060_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	061	0	1	01	01	H1045_061_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	063	0	1	02	01	H1045_063_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	064	0	1	01	01	H1045_064_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	065	0	1	02	01	H1045_065_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1045	067	0	1	02	01	H1045_067_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	069	0	1	02	01	H1045_069_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1045	801	0	1	01	01	H1045_801_0	1				1																																																																				
H1045	802	0	1	01	01	H1045_802_0	1	N	N		2																																																																				
H1045	803	0	1	01	01	H1045_803_0	1				1																																																																				
H1045	804	0	2	01	01	H1045_804_0	1				1																																																																				
H1099	001	0	1	02	01	H1099_001_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	006	0	1	01	01	H1099_006_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	009	0	1	01	01	H1099_009_0	5	N	N		2																																																																				
H1099	014	0	1	01	01	H1099_014_0	8			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	016	0	1	01	01	H1099_016_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	023	0	1	01	01	H1099_023_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	024	0	1	01	01	H1099_024_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	025	0	1	02	01	H1099_025_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	111	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	026	0	1	01	01	H1099_026_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	111	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	027	0	1	02	01	H1099_027_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	111	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1099	028	0	1	01	01	H1099_028_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	By reducing deductible and/or making the Initial Coverage Phase benefit better than defined standard (25%).  We do the latter by comparing the ratio of (a) the total patient pay during Initial Coverage Phase to (b) total Gross drug cost during ICP, to 0.25.	2	3		0101110	1																																		1		1	1
H1109	005	0	1	01	01	H1109_005_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1109	801	0	1	01	01	H1109_801_0	1	N	N		2																																																																				
H1109	802	0	1	01	01	H1109_802_0	1				1																																																																				
H1112	006	0	1	02	01	H1112_006_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1112	033	0	1	02	01	H1112_033_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1112	034	0	1	02	01	H1112_034_0	7	N	N		2																																																																				
H1112	038	0	1	02	01	H1112_038_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1112	039	0	1	02	01	H1112_039_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1112	042	0	1	02	01	H1112_042_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1112	043	0	1	02	01	H1112_043_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	565.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1112	044	0	1	02	01	H1112_044_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1112	046	0	1	02	01	H1112_046_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1112	047	0	1	02	01	H1112_047_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1112	048	0	1	02	01	H1112_048_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1112	049	0	1	02	01	H1112_049_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1119	001	0	1	01	01	H1119_001_0	4				1	1	110110	1		2											615.00																111	31	60	90	01	31		010	31			1	31	2	2	35.00	70.00	105.00	35.00			35.00		35.00	25	25	25	25			25		25			1	1
H1170	002	0	1	01	01	H1170_002_0	6			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1170	008	0	1	01	01	H1170_008_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H1170	009	0	1	01	01	H1170_009_0	6			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1170	011	0	1	01	01	H1170_011_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H1170	012	0	1	01	01	H1170_012_0	6			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1170	013	0	1	02	01	H1170_013_0	6			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1170	014	0	1	01	01	H1170_014_0	5	N	N		2																																																																				
H1170	015	0	1	01	01	H1170_015_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H1170	016	0	1	01	01	H1170_016_0	6			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1170	017	0	1	01	01	H1170_017_0	5	N	N		2																																																																				
H1170	801	0	1	01	01	H1170_801_0	3	N	N		2																																																																				
H1170	802	0	1	01	01	H1170_802_0	3				1																																																																				
H1181	001	0		07	02	H1181_001_0	3	N	N		2																																																																				
H1188	001	0	1	20	08	H1188_001_0	1				1																																																																				
H1188	003	0	1	20	08	H1188_003_0	1				1																																																																				
H1189	002	0	1	01	01	H1189_002_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1189	003	0	1	01	01	H1189_003_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1189	004	0	1	01	01	H1189_004_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1189	005	0	1	01	01	H1189_005_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1189	007	0	1	01	01	H1189_007_0	4	N	N		2																																																																				
H1189	008	0	1	01	01	H1189_008_0	4	N	N		2																																																																				
H1189	009	0	1	01	01	H1189_009_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1189	010	0	1	01	01	H1189_010_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	By offering lower cost sharing than the defined standard prescription drug coverage, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	2	3		0001110	1																																		1		1	1
H1206	002	0	1	02	01	H1206_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1206	003	0	1	02	01	H1206_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1206	004	0	1	01	01	H1206_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1206	008	0	1	02	01	H1206_008_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1206	009	0	1	01	01	H1206_009_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1206	801	0	1	01	01	H1206_801_0	1	N	N		2																																																																				
H1212	001	0	1	01	01	H1212_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1212	002	0	1	01	01	H1212_002_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1212	003	0	1	02	01	H1212_003_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H1215	001	0	1	02	01	H1215_001_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1215	003	0	1	02	01	H1215_003_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1215	005	0	1	02	01	H1215_005_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1219	001	0	1	20	08	H1219_001_0	2				1																																																																				
H1219	002	0	1	20	08	H1219_002_0	2				1																																																																				
H1224	001	0	1	01	01	H1224_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	By offering $0 cost sharing on tier 1 drugs, this plan's benefits have a higher actuarial value relative to the defined standard benefit.	2	3		0111110	1																																		1	1	1	1
H1225	001	0	1	01	01	H1225_001_0	9			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				1	1	111	This plan offers $0 copay on Tier 1 and a $6 copay on Tier 2, with a cost-share structure of the lesser of coinsurance and copayment. The average expected cost will be no more than 25% of the actual cost on Tier 2.	1	3		0111110	1																																		1		1	1
H1225	003	0	1	01	01	H1225_003_0	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	52.50	70.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1225	004	0	1	01	01	H1225_004_0	5	N	N		2																																																																				
H1228	001	0	1	20	08	H1228_001_0	3				1																																																																				
H1228	002	0	1	20	08	H1228_002_0	3				1																																																																				
H1230	001	0	1	01	01	H1230_001_0	3			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1230	003	0	1	01	01	H1230_003_0	3			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1230	013	0	1	01	01	H1230_013_0	3			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1230	014	0	1	01	01	H1230_014_0	3			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H1230	801	0	1	01	01	H1230_801_0	2	N	N		2																																																																				
H1230	803	0	1	01	01	H1230_803_0	2				1																																																																				
H1230	804	0	2	01	01	H1230_804_0	2				1																																																																				
H1234	001	0	1	20	08	H1234_001_0	2				1																																																																				
H1234	002	0	1	20	08	H1234_002_0	2				1																																																																				
H1239	001	0	1	20	08	H1239_001_0	2				1																																																																				
H1239	002	0	1	20	08	H1239_002_0	2				1																																																																				
H1248	004	0	1	04	01	H1248_004_0	13			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain Tiers.	2	3		0001100	1																																		1		1	1
H1248	007	0	1	04	01	H1248_007_0	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain Tiers.	2	3		0001100	1																																		1		1	1
H1248	014	0	1	04	01	H1248_014_0	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain Tiers.	2	3		0001100	1																																		1		1	1
H1248	801	0	1	04	01	H1248_801_0	8				1																																																																				
H1248	802	0	1	04	01	H1248_802_0	8				1																																																																				
H1248	803	0	1	04	01	H1248_803_0	8	N	N		2																																																																				
H1278	003	0	1	04	01	H1278_003_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	005	0	1	04	01	H1278_005_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	010	0	1	04	01	H1278_010_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	013	0	1	04	01	H1278_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	014	0	1	04	01	H1278_014_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	015	0	1	04	01	H1278_015_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	016	0	1	04	01	H1278_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	018	0	1	04	01	H1278_018_0	3	N	N		2																																																																				
H1278	020	0	1	04	01	H1278_020_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	021	0	1	04	01	H1278_021_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	024	0	1	04	01	H1278_024_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	025	0	1	04	01	H1278_025_0	3	N	N		2																																																																				
H1278	026	0	1	04	01	H1278_026_0	3	N	N		2																																																																				
H1278	027	0	1	04	01	H1278_027_0	3	N	N		2																																																																				
H1278	028	0	1	04	01	H1278_028_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	029	0	1	04	01	H1278_029_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	030	0	1	04	01	H1278_030_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1278	031	0	1	04	01	H1278_031_0	3	N	N		2																																																																				
H1278	032	0	1	04	01	H1278_032_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1280	001	0	1	01	01	H1280_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced co-pays for certain formulary tiers and a reduced Part D deductible, which is further waived for tiers 1, 2, and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1285	001	0	1	01	01	H1285_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H1285	002	0	1	02	01	H1285_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H1290	001	0	1	01	01	H1290_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	002	0	1	01	01	H1290_002_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	003	0	1	01	01	H1290_003_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	005	0	1	01	01	H1290_005_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	013	0	1	01	01	H1290_013_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	014	0	1	01	01	H1290_014_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	015	0	1	01	01	H1290_015_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	018	0	1	01	01	H1290_018_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	019	0	1	01	01	H1290_019_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	020	0	1	01	01	H1290_020_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	021	0	1	01	01	H1290_021_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	022	0	1	01	01	H1290_022_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	023	0	1	01	01	H1290_023_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	024	0	1	01	01	H1290_024_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	025	0	1	01	01	H1290_025_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	027	0	1	01	01	H1290_027_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	029	0	1	01	01	H1290_029_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	031	0	1	01	01	H1290_031_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	032	0	1	01	01	H1290_032_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	033	0	1	01	01	H1290_033_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	034	0	1	01	01	H1290_034_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	035	0	1	01	01	H1290_035_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	036	1	1	01	01	H1290_036_1	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	036	2	1	01	01	H1290_036_2	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	037	1	1	01	01	H1290_037_1	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	037	2	1	01	01	H1290_037_2	11			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	037	3	1	01	01	H1290_037_3	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	037	4	1	01	01	H1290_037_4	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	037	5	1	01	01	H1290_037_5	10			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	039	0	1	01	01	H1290_039_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	041	0	1	01	01	H1290_041_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	042	0	1	01	01	H1290_042_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	043	0	1	01	01	H1290_043_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	044	1	1	01	01	H1290_044_1	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	044	2	1	01	01	H1290_044_2	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	044	3	1	01	01	H1290_044_3	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	045	0	1	01	01	H1290_045_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	046	0	1	01	01	H1290_046_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	049	0	1	01	01	H1290_049_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	050	0	1	01	01	H1290_050_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	051	1	1	01	01	H1290_051_1	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	051	2	1	01	01	H1290_051_2	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	052	0	1	01	01	H1290_052_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	053	0	1	01	01	H1290_053_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	054	0	1	01	01	H1290_054_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	055	0	1	01	01	H1290_055_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	056	0	1	01	01	H1290_056_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	057	0	1	01	01	H1290_057_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	058	0	1	01	01	H1290_058_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	059	0	1	01	01	H1290_059_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	060	0	1	01	01	H1290_060_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	061	0	1	01	01	H1290_061_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	062	0	1	01	01	H1290_062_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	063	0	1	01	01	H1290_063_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	064	0	1	01	01	H1290_064_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	065	0	1	01	01	H1290_065_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	066	0	1	01	01	H1290_066_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1290	067	0	1	01	01	H1290_067_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	068	0	1	01	01	H1290_068_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	069	0	1	01	01	H1290_069_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	070	0	1	01	01	H1290_070_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	071	0	1	01	01	H1290_071_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	072	0	1	01	01	H1290_072_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	073	0	1	01	01	H1290_073_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	074	0	1	01	01	H1290_074_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	077	0	1	01	01	H1290_077_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	078	0	1	01	01	H1290_078_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	079	0	1	01	01	H1290_079_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	080	0	1	01	01	H1290_080_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	081	0	1	01	01	H1290_081_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	082	0	1	01	01	H1290_082_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	083	0	1	01	01	H1290_083_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H1290	084	0	1	01	01	H1290_084_0	9			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	085	0	1	01	01	H1290_085_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	086	0	1	01	01	H1290_086_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	087	0	1	01	01	H1290_087_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	088	0	1	01	01	H1290_088_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	089	0	1	01	01	H1290_089_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	090	0	1	01	01	H1290_090_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1290	091	0	1	01	01	H1290_091_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H1302	004	0	1	04	01	H1302_004_0	4	N	N		2																																																																				
H1302	802	0	1	04	01	H1302_802_0	2	N	N		2																																																																				
H1302	803	0	1	04	01	H1302_803_0	2				1																																																																				
H1302	804	0	1	04	01	H1302_804_0	2				1																																																																				
H1304	803	0	1	04	01	H1304_803_0	3	N	N		2																																																																				
H1304	804	0	1	04	01	H1304_804_0	3				1																																																																				
H1304	805	0	1	04	01	H1304_805_0	3				1																																																																				
H1304	806	0	1	04	01	H1304_806_0	3				1																																																																				
H1310	001	0	1	20	08	H1310_001_0	2				1																																																																				
H1310	003	0	1	20	08	H1310_003_0	2				1																																																																				
H1312	001	0	1	20	08	H1312_001_0	2				1																																																																				
H1312	002	0	1	20	08	H1312_002_0	2				1																																																																				
H1339	001	0	1	01	01	H1339_001_0	9			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	This plan offers $0 copay on Tier 1 and a $10 copay on Tier 2, with a cost-share structure of the lesser of coinsurance and copayment. The average expected cost will be no more than 25% of the actual cost on Tier 2.	1	3		0111110	1																																		1		1	1
H1347	001	0	1	04	01	H1347_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	320.00	2	0110000	1				2	1	111	The $320 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tier 2. Tiers 3, 4, and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H1347	002	0	1	04	01	H1347_002_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The $300 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tier 2. Tiers 3, 4, and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H1347	003	0	1	04	01	H1347_003_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The $325 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tier 2. Tiers 3, 4, and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
H1350	006	0	1	01	01	H1350_006_0	5	N	N		2																																																																				
H1350	032	0	1	01	01	H1350_032_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	033	0	1	01	01	H1350_033_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	034	0	1	01	01	H1350_034_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	035	0	1	01	01	H1350_035_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	036	0	1	01	01	H1350_036_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	037	0	1	01	01	H1350_037_0	8			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H1350	803	0	1	01	01	H1350_803_0	2	N	N		2																																																																				
H1350	804	0	1	01	01	H1350_804_0	2				1																																																																				
H1350	805	0	1	01	01	H1350_805_0	2				1																																																																				
H1350	806	0	1	02	01	H1350_806_0	2				1																																																																				
H1350	807	0	1	02	01	H1350_807_0	2				1																																																																				
H1357	001	0	1	20	08	H1357_001_0	2				1																																																																				
H1357	002	0	1	20	08	H1357_002_0	2				1																																																																				
H1360	001	0	1	02	01	H1360_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	36.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H1360	002	0	1	02	01	H1360_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H1360	003	0	1	02	01	H1360_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	514.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H1365	001	0	1	04	01	H1365_001_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H1365	005	0	1	04	01	H1365_005_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H1365	802	0	1	04	01	H1365_802_0	4				1																																																																				
H1365	803	0	1	04	01	H1365_803_0	4				1																																																																				
H1372	001	0	1	01	01	H1372_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	10		10	100			90	1	31	2	2	35.00	70.00	105.00			105.00		35.00	35.00	25	25	25			25		25	25			1	1
H1372	002	0	1	01	01	H1372_002_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H1372	003	0	1	01	01	H1372_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H1395	001	0	1	04	01	H1395_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1395	002	0	1	04	01	H1395_002_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1395	003	0	1	04	01	H1395_003_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	570.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1395	004	0	1	04	01	H1395_004_0	7	N	N		2																																																																				
H1396	001	0	1	01	01	H1396_001_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1416	009	0	1	02	01	H1416_009_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	026	0	1	02	01	H1416_026_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	033	0	1	02	01	H1416_033_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	034	0	1	02	01	H1416_034_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	035	0	1	02	01	H1416_035_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	042	0	1	02	01	H1416_042_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1416	043	0	1	02	01	H1416_043_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	044	0	1	02	01	H1416_044_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	055	0	1	02	01	H1416_055_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	058	0	1	02	01	H1416_058_0	7	N	N		2																																																																				
H1416	060	0	1	02	01	H1416_060_0	7	N	N		2																																																																				
H1416	061	0	1	02	01	H1416_061_0	7	N	N		2																																																																				
H1416	064	0	1	02	01	H1416_064_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	485.00	2	0110001	1				2	1	111	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	065	0	1	02	01	H1416_065_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	068	0	1	02	01	H1416_068_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1416	071	0	1	02	01	H1416_071_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	072	0	1	02	01	H1416_072_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	077	0	1	02	01	H1416_077_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	079	0	1	02	01	H1416_079_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	081	0	1	02	01	H1416_081_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1416	082	0	1	02	01	H1416_082_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1416	083	0	1	02	01	H1416_083_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1423	001	0	1	02	01	H1423_001_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H1423	002	0	1	02	01	H1423_002_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H1423	004	0	1	02	01	H1423_004_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	125.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H1423	005	0	1	01	01	H1423_005_0	7			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	125.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H1423	007	0	1	01	01	H1423_007_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001101	1																																		1		1	1
H1423	008	0	1	01	01	H1423_008_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001101	1																																		1		1	1
H1423	009	0	1	02	01	H1423_009_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H1468	007	0	1	01	01	H1468_007_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1468	013	0	1	01	01	H1468_013_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1468	017	0	1	01	01	H1468_017_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1468	021	0	1	01	01	H1468_021_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H1468	802	0	1	01	01	H1468_802_0	4				1																																																																				
H1468	803	0	1	01	01	H1468_803_0	3	N	N		2																																																																				
H1468	805	0	1	01	01	H1468_805_0	3				1																																																																				
H1468	806	0	1	01	01	H1468_806_0	3	N	N		2																																																																				
H1486	001	0	1	01	01	H1486_001_0	6		N		1	1	110110	1		2											615.00																111	31	60	100	01	31		111	31	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1500	001	0	1	20	08	H1500_001_0	2				1																																																																				
H1500	002	0	1	20	08	H1500_002_0	2				1																																																																				
H1518	001	0	1	20	08	H1518_001_0	2				1																																																																				
H1518	002	0	1	20	08	H1518_002_0	2				1																																																																				
H1526	001	0	1	02	01	H1526_001_0	5			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tiers 1 and 2, and reduced copays on tiers 3-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H1526	002	0	1	02	01	H1526_002_0	5			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		1	615.00	1						1	1	100	This plan offers 24% coinsurance on Tiers 1 through 3 and 15% coinsurance on Tier 6.	2	3		0000101	1																																		1		1	1
H1526	003	0	1	02	01	H1526_003_0	5			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tier 1, and reduced copays on tiers 2-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H1526	004	0	1	02	01	H1526_004_0	4				1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1526	008	0	1	02	01	H1526_008_0	4			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tiers 1 and 2, and reduced copays on tiers 3-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H1526	009	0	1	02	01	H1526_009_0	4			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tier 1, and reduced copays on tiers 2-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H1533	001	0	1	20	08	H1533_001_0	2				1																																																																				
H1533	002	0	1	20	08	H1533_002_0	2				1																																																																				
H1537	801	0	1	04	01	H1537_801_0	1				1																																																																				
H1537	802	0	1	04	01	H1537_802_0	1	N	N		2																																																																				
H1537	803	0	1	04	01	H1537_803_0	1				1																																																																				
H1537	804	0	2	04	01	H1537_804_0	1				1																																																																				
H1537	805	0	2	04	01	H1537_805_0	1	N	N		2																																																																				
H1537	806	0	2	04	01	H1537_806_0	1				1																																																																				
H1537	807	0	1	04	01	H1537_807_0	1				1																																																																				
H1537	808	0	1	04	01	H1537_808_0	1	N	N		2																																																																				
H1537	809	0	1	04	01	H1537_809_0	1				1																																																																				
H1537	816	0	1	04	01	H1537_816_0	1				1																																																																				
H1537	817	0	1	04	01	H1537_817_0	1				1																																																																				
H1537	823	0	1	04	01	H1537_823_0	1				1																																																																				
H1537	824	0	1	04	01	H1537_824_0	1				1																																																																				
H1537	825	0	1	04	01	H1537_825_0	1	N	N		2																																																																				
H1537	826	0	1	04	01	H1537_826_0	1				1																																																																				
H1537	827	0	2	04	01	H1537_827_0	1				1																																																																				
H1537	828	0	2	04	01	H1537_828_0	1	N	N		2																																																																				
H1537	829	0	2	04	01	H1537_829_0	1				1																																																																				
H1537	830	0	1	04	01	H1537_830_0	1				1																																																																				
H1537	831	0	1	04	01	H1537_831_0	1				1																																																																				
H1537	832	0	1	04	01	H1537_832_0	1				1																																																																				
H1537	833	0	1	04	01	H1537_833_0	1				1																																																																				
H1537	834	0	1	04	01	H1537_834_0	1				1																																																																				
H1537	835	0	2	04	01	H1537_835_0	1				1																																																																				
H1537	836	0	1	04	01	H1537_836_0	1	N	N		2																																																																				
H1537	837	0	1	04	01	H1537_837_0	1				1																																																																				
H1537	838	0	1	04	01	H1537_838_0	1				1																																																																				
H1537	839	0	1	04	01	H1537_839_0	1				1																																																																				
H1537	840	0	1	04	01	H1537_840_0	1				1																																																																				
H1537	841	0	1	04	01	H1537_841_0	1				1																																																																				
H1537	842	0	1	04	01	H1537_842_0	1				1																																																																				
H1537	843	0	1	04	01	H1537_843_0	1				1																																																																				
H1537	844	0	1	04	01	H1537_844_0	1				1																																																																				
H1537	845	0	1	04	01	H1537_845_0	1				1																																																																				
H1537	846	0	1	04	01	H1537_846_0	1				1																																																																				
H1537	847	0	1	04	01	H1537_847_0	1				1																																																																				
H1537	848	0	1	04	01	H1537_848_0	1				1																																																																				
H1537	849	0	1	04	01	H1537_849_0	1	N	N		2																																																																				
H1537	850	0	1	04	01	H1537_850_0	1				1																																																																				
H1537	851	0	1	04	01	H1537_851_0	1				1																																																																				
H1537	852	0	1	04	01	H1537_852_0	1				1																																																																				
H1537	853	0	1	04	01	H1537_853_0	1	N	N		2																																																																				
H1537	854	0	1	04	01	H1537_854_0	1	N	N		2																																																																				
H1537	855	0	1	04	01	H1537_855_0	1				1																																																																				
H1537	856	0	1	04	01	H1537_856_0	1				1																																																																				
H1537	857	0	1	04	01	H1537_857_0	1	N	N		2																																																																				
H1537	858	0	1	04	01	H1537_858_0	1	N	N		2																																																																				
H1537	859	0	1	04	01	H1537_859_0	1				1																																																																				
H1537	860	0	1	04	01	H1537_860_0	1				1																																																																				
H1537	861	0	1	04	01	H1537_861_0	1	N	N		2																																																																				
H1537	862	0	1	04	01	H1537_862_0	1				1																																																																				
H1537	863	0	1	04	01	H1537_863_0	1	N	N		2																																																																				
H1537	864	0	1	04	01	H1537_864_0	1	N	N		2																																																																				
H1537	865	0	1	04	01	H1537_865_0	1				1																																																																				
H1537	866	0	1	04	01	H1537_866_0	1				1																																																																				
H1537	867	0	1	04	01	H1537_867_0	1	N	N		2																																																																				
H1537	868	0	1	04	01	H1537_868_0	1				1																																																																				
H1537	869	0	1	04	01	H1537_869_0	1				1																																																																				
H1544	001	0	1	20	08	H1544_001_0	2				1																																																																				
H1544	002	0	1	20	08	H1544_002_0	2				1																																																																				
H1587	001	0	1	01	01	H1587_001_0	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1587	003	0	1	02	01	H1587_003_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1607	012	0	1	04	01	H1607_012_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H1607	015	0	1	04	01	H1607_015_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H1607	809	0	1	04	01	H1607_809_0	3				1																																																																				
H1607	811	0	1	04	01	H1607_811_0	3	N	N		2																																																																				
H1607	812	0	1	04	01	H1607_812_0	3	N	N		2																																																																				
H1607	813	0	1	04	01	H1607_813_0	3				1																																																																				
H1607	815	0	1	04	01	H1607_815_0	3	N	N		2																																																																				
H1607	816	0	1	04	01	H1607_816_0	3	N	N		2																																																																				
H1607	817	0	2	04	01	H1607_817_0	3				1																																																																				
H1607	819	0	2	04	01	H1607_819_0	3	N	N		2																																																																				
H1607	820	0	2	04	01	H1607_820_0	3	N	N		2																																																																				
H1608	001	0	1	04	01	H1608_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	012	0	1	04	01	H1608_012_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	013	0	1	04	01	H1608_013_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	016	0	1	04	01	H1608_016_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	017	0	1	04	01	H1608_017_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	018	0	1	04	01	H1608_018_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	021	0	1	04	01	H1608_021_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	024	0	1	04	01	H1608_024_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	027	0	1	04	01	H1608_027_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	028	0	1	04	01	H1608_028_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	029	0	1	04	01	H1608_029_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	031	0	1	04	01	H1608_031_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	037	0	1	04	01	H1608_037_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	038	0	1	04	01	H1608_038_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	040	0	1	04	01	H1608_040_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	050	0	1	04	01	H1608_050_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	051	0	1	04	01	H1608_051_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	052	0	1	04	01	H1608_052_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	054	0	1	04	01	H1608_054_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	061	0	1	04	01	H1608_061_0	2	N	N		2																																																																				
H1608	062	0	1	04	01	H1608_062_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1608	067	0	1	04	01	H1608_067_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	070	0	1	04	01	H1608_070_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	072	0	1	04	01	H1608_072_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	074	0	1	04	01	H1608_074_0	2	N	N		2																																																																				
H1608	076	0	1	04	01	H1608_076_0	2		N	5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1608	077	0	1	04	01	H1608_077_0	2		N	5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1608	079	0	1	04	01	H1608_079_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	081	0	1	04	01	H1608_081_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	085	0	1	04	01	H1608_085_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	105	0	1	04	01	H1608_105_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	109	0	1	04	01	H1608_109_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	117	0	1	04	01	H1608_117_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	118	0	1	04	01	H1608_118_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	119	0	1	04	01	H1608_119_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	120	0	1	04	01	H1608_120_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1608	121	0	1	04	01	H1608_121_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1608	801	0	1	04	01	H1608_801_0	1	N	N		2																																																																				
H1609	001	0	1	02	01	H1609_001_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	017	0	1	01	01	H1609_017_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	018	0	1	01	01	H1609_018_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a $0 Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	019	0	1	01	01	H1609_019_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	020	0	1	01	01	H1609_020_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a $0 Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	021	0	1	01	01	H1609_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	022	0	1	01	01	H1609_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	025	0	1	01	01	H1609_025_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	027	0	1	01	01	H1609_027_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a $0 Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	028	0	1	02	01	H1609_028_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	041	0	1	01	01	H1609_041_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	043	0	1	01	01	H1609_043_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	044	0	1	01	01	H1609_044_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	045	0	1	01	01	H1609_045_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	046	0	1	01	01	H1609_046_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	047	0	1	01	01	H1609_047_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	048	0	1	01	01	H1609_048_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	049	0	1	01	01	H1609_049_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	055	0	1	01	01	H1609_055_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	056	0	1	01	01	H1609_056_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	058	0	1	02	01	H1609_058_0	3	N	N		2																																																																				
H1609	059	0	1	01	01	H1609_059_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	061	0	1	01	01	H1609_061_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	062	0	1	01	01	H1609_062_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	063	0	1	01	01	H1609_063_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	064	0	1	01	01	H1609_064_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	068	0	1	02	01	H1609_068_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	069	0	1	02	01	H1609_069_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	073	0	1	01	01	H1609_073_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	074	0	1	01	01	H1609_074_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	075	0	1	01	01	H1609_075_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	076	0	1	01	01	H1609_076_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	077	0	1	01	01	H1609_077_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	078	0	1	01	01	H1609_078_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	079	0	1	01	01	H1609_079_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	080	0	1	01	01	H1609_080_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	081	0	1	01	01	H1609_081_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	082	0	1	01	01	H1609_082_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	083	0	1	01	01	H1609_083_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	084	0	1	01	01	H1609_084_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	085	0	1	01	01	H1609_085_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	086	0	1	01	01	H1609_086_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	087	0	1	01	01	H1609_087_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	088	0	1	01	01	H1609_088_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	089	0	1	01	01	H1609_089_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	090	0	1	01	01	H1609_090_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	092	0	1	01	01	H1609_092_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1609	093	0	1	01	01	H1609_093_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	094	0	1	01	01	H1609_094_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1609	801	0	1	01	01	H1609_801_0	1	N	N		2																																																																				
H1609	807	0	1	01	01	H1609_807_0	1				1																																																																				
H1610	001	0	1	01	01	H1610_001_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1611	001	0	1	01	01	H1611_001_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	1	2	35.00	70.00	105.00	35.00	70.00	70.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1619	001	0	1	04	01	H1619_001_0	20			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan does not charge members a Part D deductible and offers competitive lower cost share at all tiers	2	3		0001110	1																																		1		1	1
H1619	002	0	1	04	01	H1619_002_0	19			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan does not charge members a Part D deductible and offers competitive lower cost share at all tiers	2	3		0001110	1																																		1		1	1
H1619	003	0	1	04	01	H1619_003_0	20			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan does not charge members a Part D deductible and offers competitive lower cost share at all tiers	2	3		0001110	1																																		1		1	1
H1622	001	0	1	20	08	H1622_001_0	2				1																																																																				
H1622	003	0	1	20	08	H1622_003_0	2				1																																																																				
H1644	001	0	1	01	01	H1644_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H1651	001	0	1	18	06	H1651_001_0	1	N	N		2																																																																				
H1651	002	0	1	18	06	H1651_002_0	1	N	N		2																																																																				
H1651	003	0	1	18	06	H1651_003_0	1	N	N		2																																																																				
H1651	004	0	1	18	06	H1651_004_0	1	N	N		2																																																																				
H1651	005	0	1	18	06	H1651_005_0	1	N	N		2																																																																				
H1651	008	0	1	18	06	H1651_008_0	2	N	N		2																																																																				
H1651	009	0	1	18	06	H1651_009_0	2	N	N		2																																																																				
H1651	013	0	1	18	06	H1651_013_0	1	N	N		2																																																																				
H1651	015	0	1	18	06	H1651_015_0	1	N	N		2																																																																				
H1659	002	0	1	04	01	H1659_002_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1664	001	0	1	02	01	H1664_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1664	005	0	1	02	01	H1664_005_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1664	006	0	1	02	01	H1664_006_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1664	012	0	1	02	01	H1664_012_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H1666	003	0	1	04	01	H1666_003_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	006	0	1	04	01	H1666_006_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	008	0	1	04	01	H1666_008_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	012	0	1	04	01	H1666_012_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	014	0	1	04	01	H1666_014_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	016	0	1	04	01	H1666_016_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	019	0	1	04	01	H1666_019_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	020	0	1	04	01	H1666_020_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	021	0	1	04	01	H1666_021_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	022	0	1	04	01	H1666_022_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	023	0	1	04	01	H1666_023_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	024	0	1	04	01	H1666_024_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H1666	801	0	1	04	01	H1666_801_0	2				1																																																																				
H1666	803	0	1	04	01	H1666_803_0	2				1																																																																				
H1666	805	0	1	04	01	H1666_805_0	2	N	N		2																																																																				
H1666	807	0	1	04	01	H1666_807_0	2				1																																																																				
H1666	808	0	1	04	01	H1666_808_0	2	N	N		2																																																																				
H1671	001	0	1	01	01	H1671_001_0	6		N	5A4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Deductible is waived for Tiers 1 & 6, as well as reduced cost sharing to $0 for both Tiers 1 & 6.	2	3		0111111	1																																		1	1	1	1
H1692	002	0	1	01	01	H1692_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1692	003	0	1	01	01	H1692_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1692	005	0	1	01	01	H1692_005_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H1692	006	0	1	01	01	H1692_006_0	2	N	N		2																																																																				
H1692	007	0	1	01	01	H1692_007_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H1692	801	0	1	01	01	H1692_801_0	1	N	N		2																																																																				
H1693	002	0	1	20	08	H1693_002_0	2				1																																																																				
H1693	003	0	1	20	08	H1693_003_0	2				1																																																																				
H1714	001	0	1	20	08	H1714_001_0	3				1																																																																				
H1714	002	0	1	20	08	H1714_002_0	3				1																																																																				
H1722	002	0	1	01	01	H1722_002_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	1	3		0111111	3																																		1		1	1
H1742	001	0	1	20	08	H1742_001_0	2				1																																																																				
H1742	002	0	1	20	08	H1742_002_0	2				1																																																																				
H1787	001	0	1	01	01	H1787_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H1787	002	0	1	01	01	H1787_002_0	6			5F4	1	4	110100	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																				1	1
H1799	003	1	1	01	01	H1799_003_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H1799	003	2	1	01	01	H1799_003_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H1799	003	3	1	01	01	H1799_003_3	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H1799	004	0	1	01	01	H1799_004_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6	2	3		0001110	1																																		1	1	1	1
H1799	005	0	1	01	01	H1799_005_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H1822	001	0	1	01	01	H1822_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H1822	002	0	1	01	01	H1822_002_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H1822	005	0	1	02	01	H1822_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H1822	006	0	1	01	01	H1822_006_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H1822	007	0	1	01	01	H1822_007_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H1822	008	0	1	02	01	H1822_008_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H1822	801	0	1	01	01	H1822_801_0	4				1																																																																				
H1822	802	0	1	01	01	H1822_802_0	4				1																																																																				
H1822	803	0	1	01	01	H1822_803_0	4	N	N		2																																																																				
H1822	804	0	1	01	01	H1822_804_0	4	N	N		2																																																																				
H1846	005	0	1	04	01	H1846_005_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1846	006	0	1	04	01	H1846_006_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1846	007	0	1	04	01	H1846_007_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H1846	801	0	1	04	01	H1846_801_0	1				1																																																																				
H1846	803	0	1	04	01	H1846_803_0	1				1																																																																				
H1846	804	0	1	04	01	H1846_804_0	1				1																																																																				
H1846	805	0	1	04	01	H1846_805_0	1				1																																																																				
H1862	003	0	1	02	01	H1862_003_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1862	004	0	1	02	01	H1862_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H1862	005	0	1	02	01	H1862_005_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1862	006	0	1	02	01	H1862_006_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H1889	002	1	1	04	01	H1889_002_1	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	002	2	1	04	01	H1889_002_2	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	005	0	1	04	01	H1889_005_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	007	0	1	04	01	H1889_007_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	008	0	1	04	01	H1889_008_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	009	0	1	04	01	H1889_009_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	010	0	1	04	01	H1889_010_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	011	0	1	04	01	H1889_011_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	012	0	1	04	01	H1889_012_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	013	0	1	04	01	H1889_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	014	0	1	04	01	H1889_014_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	015	0	1	04	01	H1889_015_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	016	0	1	04	01	H1889_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	017	0	1	04	01	H1889_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	018	0	1	04	01	H1889_018_0	3	N	N		2																																																																				
H1889	019	0	1	04	01	H1889_019_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	020	0	1	04	01	H1889_020_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	022	0	1	04	01	H1889_022_0	3	N	N		2																																																																				
H1889	025	0	1	04	01	H1889_025_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1889	026	0	1	04	01	H1889_026_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	028	0	1	04	01	H1889_028_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H1889	030	0	1	04	01	H1889_030_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	031	0	1	04	01	H1889_031_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	032	0	1	04	01	H1889_032_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	034	0	1	04	01	H1889_034_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1889	035	0	1	04	01	H1889_035_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	10.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H1894	002	0	1	01	01	H1894_002_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1894	011	0	1	01	01	H1894_011_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1904	001	0	1	20	08	H1904_001_0	2				1																																																																				
H1904	002	0	1	20	08	H1904_002_0	3				1																																																																				
H1914	001	0	1	04	01	H1914_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1914	002	0	1	04	01	H1914_002_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1914	007	0	1	04	01	H1914_007_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1914	008	0	1	04	01	H1914_008_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	395.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H1914	009	0	1	04	01	H1914_009_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	480.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H1914	010	0	1	04	01	H1914_010_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H1914	011	0	1	04	01	H1914_011_0	7	N	N		2																																																																				
H1917	001	0	1	20	08	H1917_001_0	2				1																																																																				
H1917	002	0	1	20	08	H1917_002_0	2				1																																																																				
H1947	001	0	1	01	01	H1947_001_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1947	003	0	1	01	01	H1947_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1947	004	0	1	01	01	H1947_004_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H1951	013	0	1	01	01	H1951_013_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	024	0	1	01	01	H1951_024_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	028	0	1	01	01	H1951_028_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	032	0	1	01	01	H1951_032_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1951	038	0	1	01	01	H1951_038_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	039	0	1	01	01	H1951_039_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	041	0	1	01	01	H1951_041_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1951	044	0	1	01	01	H1951_044_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H1951	047	1	1	01	01	H1951_047_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	047	2	1	01	01	H1951_047_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	048	1	1	01	01	H1951_048_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	048	2	1	01	01	H1951_048_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	049	1	1	01	01	H1951_049_1	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	049	2	1	01	01	H1951_049_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	049	3	1	01	01	H1951_049_3	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	051	0	1	01	01	H1951_051_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	052	0	1	01	01	H1951_052_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	053	0	1	01	01	H1951_053_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	056	0	1	01	01	H1951_056_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1951	057	0	1	01	01	H1951_057_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1951	058	0	1	01	01	H1951_058_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	059	0	1	01	01	H1951_059_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H1951	060	0	1	01	01	H1951_060_0	1	N	N		2																																																																				
H1951	061	0	1	01	01	H1951_061_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H1951	801	0	1	01	01	H1951_801_0	1				1																																																																				
H1951	804	0	1	01	01	H1951_804_0	2	N	N		2																																																																				
H1951	807	0	1	01	01	H1951_807_0	1				1																																																																				
H1951	808	0	1	01	01	H1951_808_0	1	N	N		2																																																																				
H1961	003	0	1	02	01	H1961_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1961	014	1	1	02	01	H1961_014_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	014	2	1	02	01	H1961_014_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	014	3	1	02	01	H1961_014_3	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	014	4	1	02	01	H1961_014_4	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	017	0	1	02	01	H1961_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	019	0	1	02	01	H1961_019_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1961	020	0	1	02	01	H1961_020_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	022	0	1	02	01	H1961_022_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	023	0	1	02	01	H1961_023_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	024	0	1	02	01	H1961_024_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H1961	025	0	1	02	01	H1961_025_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H1961	026	0	1	02	01	H1961_026_0	3	N	N		2																																																																				
H1961	801	0	1	02	01	H1961_801_0	1				1																																																																				
H1961	802	0	1	02	01	H1961_802_0	1				1																																																																				
H1961	803	0	1	01	01	H1961_803_0	1				1																																																																				
H1961	804	0	1	01	01	H1961_804_0	1				1																																																																				
H1969	805	0	1	01	01	H1969_805_0	2				1																																																																				
H1980	001	0	1	20	08	H1980_001_0	2				1																																																																				
H1980	002	0	1	20	08	H1980_002_0	2				1																																																																				
H1993	001	0	1	01	01	H1993_001_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	50.00	2	0110001	1				2	1	111	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	007	0	1	01	01	H1993_007_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus, reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	008	0	1	01	01	H1993_008_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	011	0	1	01	01	H1993_011_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	012	0	1	01	01	H1993_012_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, a Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	013	0	1	01	01	H1993_013_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1993	015	0	1	01	01	H1993_015_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, Astiva (H1993) has made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; Astiva has incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on all tiers except specialty; thus reducing the cost sharing in the initial phases.	1	3		0001100	1																																				1	1
H1994	001	0	1	01	01	H1994_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit.	2	3		0001100	1																																		1		1	1
H1994	012	0	1	01	01	H1994_012_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	015	0	1	01	01	H1994_015_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1994	016	0	1	01	01	H1994_016_0	1	N	N		2																																																																				
H1994	017	0	1	01	01	H1994_017_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																		1		1	1
H1994	021	0	1	01	01	H1994_021_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	022	0	1	01	01	H1994_022_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																		1		1	1
H1994	027	0	1	01	01	H1994_027_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	029	0	1	01	01	H1994_029_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	030	0	1	01	01	H1994_030_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	031	0	1	01	01	H1994_031_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																		1		1	1
H1994	033	0	1	01	01	H1994_033_0	3	N	N		2																																																																				
H1994	034	0	1	01	01	H1994_034_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																				1	1
H1994	035	0	1	01	01	H1994_035_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																		1		1	1
H1994	040	0	1	01	01	H1994_040_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H1994	044	0	1	01	01	H1994_044_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on tiers 1 and 2 compared to the defined standard benefit	2	3		0001100	1																																		1		1	1
H1994	801	0	1	01	01	H1994_801_0	2				1																																																																				
H1994	802	0	1	01	01	H1994_802_0	2	N	N		2																																																																				
H1994	803	0	1	01	01	H1994_803_0	2				1																																																																				
H1997	013	0	1	01	01	H1997_013_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H2001	010	0	1	04	01	H2001_010_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	017	0	1	04	01	H2001_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	019	0	1	04	01	H2001_019_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	021	0	1	04	01	H2001_021_0	3	N	N		2																																																																				
H2001	023	0	1	04	01	H2001_023_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	028	0	1	04	01	H2001_028_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	030	0	1	04	01	H2001_030_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	031	0	1	04	01	H2001_031_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	032	0	1	04	01	H2001_032_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	034	0	1	04	01	H2001_034_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	035	0	1	04	01	H2001_035_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	036	0	1	04	01	H2001_036_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	037	0	1	04	01	H2001_037_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1		1	1
H2001	038	0	1	04	01	H2001_038_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1		1	1
H2001	039	0	1	04	01	H2001_039_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	040	0	1	04	01	H2001_040_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	041	0	1	04	01	H2001_041_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	042	0	1	04	01	H2001_042_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	491.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1		1	1
H2001	043	0	1	04	01	H2001_043_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	044	0	1	04	01	H2001_044_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	513.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1		1	1
H2001	045	0	1	04	01	H2001_045_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	046	0	1	04	01	H2001_046_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	047	0	1	04	01	H2001_047_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	048	0	1	04	01	H2001_048_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	049	0	1	04	01	H2001_049_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	050	0	1	04	01	H2001_050_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	051	0	1	04	01	H2001_051_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	052	0	1	04	01	H2001_052_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	053	0	1	04	01	H2001_053_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	054	0	1	04	01	H2001_054_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	055	0	1	04	01	H2001_055_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	056	0	1	04	01	H2001_056_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	058	0	1	04	01	H2001_058_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H2001	059	0	1	04	01	H2001_059_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	060	0	1	04	01	H2001_060_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	061	0	1	04	01	H2001_061_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	062	0	1	04	01	H2001_062_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	063	1	1	04	01	H2001_063_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	063	2	1	04	01	H2001_063_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	065	0	1	04	01	H2001_065_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	066	0	1	04	01	H2001_066_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	068	1	1	04	01	H2001_068_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	068	2	1	04	01	H2001_068_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	069	1	1	04	01	H2001_069_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	069	2	1	04	01	H2001_069_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	070	0	1	04	01	H2001_070_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	075	0	1	04	01	H2001_075_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	076	0	1	04	01	H2001_076_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	077	0	1	04	01	H2001_077_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	078	0	1	04	01	H2001_078_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	079	0	1	04	01	H2001_079_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	080	0	1	04	01	H2001_080_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	081	0	1	04	01	H2001_081_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	082	0	1	04	01	H2001_082_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	083	1	1	04	01	H2001_083_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	083	2	1	04	01	H2001_083_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	084	0	1	04	01	H2001_084_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	085	0	1	04	01	H2001_085_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2001	087	0	1	04	01	H2001_087_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	090	0	1	04	01	H2001_090_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	094	0	1	04	01	H2001_094_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	095	0	1	04	01	H2001_095_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	096	0	1	04	01	H2001_096_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	097	0	1	04	01	H2001_097_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	098	0	1	04	01	H2001_098_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	099	0	1	04	01	H2001_099_0	3	N	N		2																																																																				
H2001	102	0	1	04	01	H2001_102_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	103	0	1	04	01	H2001_103_0	3	N	N		2																																																																				
H2001	104	0	1	04	01	H2001_104_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	108	0	1	04	01	H2001_108_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	109	0	1	04	01	H2001_109_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	110	0	1	04	01	H2001_110_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	115	0	1	04	01	H2001_115_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	116	0	1	04	01	H2001_116_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	117	0	1	04	01	H2001_117_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	118	0	1	04	01	H2001_118_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	119	0	1	04	01	H2001_119_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	120	0	1	04	01	H2001_120_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	123	0	1	04	01	H2001_123_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	124	0	1	04	01	H2001_124_0	3	N	N		2																																																																				
H2001	125	0	1	04	01	H2001_125_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	126	0	1	04	01	H2001_126_0	3	N	N		2																																																																				
H2001	127	0	1	04	01	H2001_127_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	128	0	1	04	01	H2001_128_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	131	0	1	04	01	H2001_131_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	132	0	1	04	01	H2001_132_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	133	0	1	04	01	H2001_133_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	134	0	1	04	01	H2001_134_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	135	0	1	04	01	H2001_135_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2001	136	0	1	04	01	H2001_136_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	137	0	1	04	01	H2001_137_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	138	0	1	04	01	H2001_138_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2001	139	0	1	04	01	H2001_139_0	3	N	N		2																																																																				
H2001	816	0	1	04	01	H2001_816_0	1				1																																																																				
H2001	817	0	1	04	01	H2001_817_0	1	N	N		2																																																																				
H2001	818	0	1	04	01	H2001_818_0	1				1																																																																				
H2001	819	0	2	04	01	H2001_819_0	1				1																																																																				
H2001	820	0	2	04	01	H2001_820_0	1	N	N		2																																																																				
H2001	821	0	2	04	01	H2001_821_0	1				1																																																																				
H2001	822	0	1	04	01	H2001_822_0	1				1																																																																				
H2001	823	0	1	04	01	H2001_823_0	1	N	N		2																																																																				
H2001	824	0	1	04	01	H2001_824_0	1				1																																																																				
H2001	825	0	1	04	01	H2001_825_0	1				1																																																																				
H2001	826	0	1	04	01	H2001_826_0	1				1																																																																				
H2001	827	0	1	04	01	H2001_827_0	1				1																																																																				
H2001	828	0	1	04	01	H2001_828_0	1				1																																																																				
H2001	829	0	1	04	01	H2001_829_0	1				1																																																																				
H2001	830	0	1	04	01	H2001_830_0	1	N	N		2																																																																				
H2001	831	0	1	04	01	H2001_831_0	1				1																																																																				
H2001	832	0	2	04	01	H2001_832_0	1				1																																																																				
H2001	833	0	2	04	01	H2001_833_0	1	N	N		2																																																																				
H2001	834	0	2	04	01	H2001_834_0	1				1																																																																				
H2001	835	0	1	04	01	H2001_835_0	1				1																																																																				
H2001	836	0	1	04	01	H2001_836_0	1				1																																																																				
H2001	837	0	1	04	01	H2001_837_0	1				1																																																																				
H2001	838	0	1	04	01	H2001_838_0	1				1																																																																				
H2001	839	0	2	04	01	H2001_839_0	1				1																																																																				
H2001	840	0	1	04	01	H2001_840_0	1	N	N		2																																																																				
H2001	841	0	1	04	01	H2001_841_0	1				1																																																																				
H2001	842	0	1	04	01	H2001_842_0	1				1																																																																				
H2001	843	0	1	04	01	H2001_843_0	1				1																																																																				
H2001	844	0	1	04	01	H2001_844_0	1				1																																																																				
H2001	845	0	1	04	01	H2001_845_0	1				1																																																																				
H2001	846	0	1	04	01	H2001_846_0	1				1																																																																				
H2001	847	0	1	04	01	H2001_847_0	1				1																																																																				
H2001	848	0	1	04	01	H2001_848_0	1				1																																																																				
H2001	849	0	1	04	01	H2001_849_0	1	N	N		2																																																																				
H2001	850	0	1	04	01	H2001_850_0	1	N	N		2																																																																				
H2001	851	0	1	04	01	H2001_851_0	1	N	N		2																																																																				
H2001	852	0	1	04	01	H2001_852_0	1	N	N		2																																																																				
H2001	853	0	1	04	01	H2001_853_0	1				1																																																																				
H2001	854	0	1	04	01	H2001_854_0	1	N	N		2																																																																				
H2001	855	0	1	04	01	H2001_855_0	1				1																																																																				
H2001	856	0	1	04	01	H2001_856_0	1	N	N		2																																																																				
H2001	857	0	1	04	01	H2001_857_0	1				1																																																																				
H2001	858	0	1	04	01	H2001_858_0	1				1																																																																				
H2001	859	0	1	04	01	H2001_859_0	1				1																																																																				
H2001	860	0	1	04	01	H2001_860_0	1	N	N		2																																																																				
H2001	861	0	1	04	01	H2001_861_0	1				1																																																																				
H2001	862	0	1	04	01	H2001_862_0	1				1																																																																				
H2001	863	0	1	04	01	H2001_863_0	1				1																																																																				
H2001	864	0	1	04	01	H2001_864_0	1				1																																																																				
H2001	865	0	1	04	01	H2001_865_0	1				1																																																																				
H2001	866	0	1	04	01	H2001_866_0	1				1																																																																				
H2001	867	0	1	04	01	H2001_867_0	1				1																																																																				
H2001	868	0	1	04	01	H2001_868_0	1				1																																																																				
H2001	869	0	1	04	01	H2001_869_0	1	N	N		2																																																																				
H2001	870	0	1	04	01	H2001_870_0	1				1																																																																				
H2001	871	0	1	04	01	H2001_871_0	1	N	N		2																																																																				
H2001	872	0	1	04	01	H2001_872_0	1	N	N		2																																																																				
H2001	873	0	1	04	01	H2001_873_0	1				1																																																																				
H2001	874	0	1	04	01	H2001_874_0	1				1																																																																				
H2001	875	0	1	04	01	H2001_875_0	1				1																																																																				
H2001	876	0	1	04	01	H2001_876_0	1				1																																																																				
H2001	877	0	1	04	01	H2001_877_0	1				1																																																																				
H2001	878	0	1	04	01	H2001_878_0	1				1																																																																				
H2001	879	0	1	04	01	H2001_879_0	1				1																																																																				
H2001	880	0	1	04	01	H2001_880_0	1				1																																																																				
H2001	881	0	1	04	01	H2001_881_0	1				1																																																																				
H2001	882	0	1	04	01	H2001_882_0	1				1																																																																				
H2001	883	0	1	04	01	H2001_883_0	1				1																																																																				
H2001	884	0	1	04	01	H2001_884_0	1	N	N		2																																																																				
H2001	886	0	1	04	01	H2001_886_0	1	N	N		2																																																																				
H2001	887	0	1	04	01	H2001_887_0	1	N	N		2																																																																				
H2001	888	0	1	04	01	H2001_888_0	1	N	N		2																																																																				
H2001	889	0	1	04	01	H2001_889_0	1	N	N		2																																																																				
H2001	890	0	1	04	01	H2001_890_0	1	N	N		2																																																																				
H2001	891	0	1	04	01	H2001_891_0	1	N	N		2																																																																				
H2001	892	0	1	04	01	H2001_892_0	1	N	N		2																																																																				
H2001	893	0	1	04	01	H2001_893_0	1	N	N		2																																																																				
H2001	894	0	1	04	01	H2001_894_0	1	N	N		2																																																																				
H2001	895	0	1	04	01	H2001_895_0	1	N	N		2																																																																				
H2001	896	0	1	04	01	H2001_896_0	1	N	N		2																																																																				
H2001	897	0	1	04	01	H2001_897_0	1	N	N		2																																																																				
H2029	801	0	1	04	01	H2029_801_0	2				1																																																																				
H2029	802	0	1	04	01	H2029_802_0	1	N	N		2																																																																				
H2029	805	0	2	04	01	H2029_805_0	1				1																																																																				
H2029	806	0	2	04	01	H2029_806_0	1	N	N		2																																																																				
H2029	809	0	1	04	01	H2029_809_0	1				1																																																																				
H2029	810	0	1	04	01	H2029_810_0	1	N	N		2																																																																				
H2029	811	0	1	04	01	H2029_811_0	1				1																																																																				
H2029	812	0	1	04	01	H2029_812_0	1	N	N		2																																																																				
H2029	815	0	1	04	01	H2029_815_0	1				1																																																																				
H2029	816	0	1	04	01	H2029_816_0	1	N	N		2																																																																				
H2029	821	0	1	04	01	H2029_821_0	1				1																																																																				
H2029	822	0	1	04	01	H2029_822_0	1	N	N		2																																																																				
H2032	001	0	1	04	01	H2032_001_0	8			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $300 for tiers 3, 4 & 5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H2032	002	0	1	04	01	H2032_002_0	10			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $250 for tiers 3, 4 & 5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H2032	003	0	1	04	01	H2032_003_0	10			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	50.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $50 for tiers 3, 4 & 5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H2032	004	0	1	04	01	H2032_004_0	10			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $300 for tiers 3, 4 & 5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H2032	801	0	1	04	01	H2032_801_0	1				1																																																																				
H2032	802	0	1	04	01	H2032_802_0	1	N	N		2																																																																				
H2032	803	0	1	04	01	H2032_803_0	1				1																																																																				
H2032	804	0	1	04	01	H2032_804_0	1	N	N		2																																																																				
H2034	001	0	1	01	01	H2034_001_0	5		N		1	1	110100	1		2											615.00																010	34			01	34		000				1	34			35.00						35.00		35.00	25						25		25			1	1
H2035	001	0	1	01	01	H2035_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	1	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2041	001	0	1	01	01	H2041_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	385.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	002	0	1	01	01	H2041_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	003	0	1	01	01	H2041_003_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	004	0	1	01	01	H2041_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	005	0	1	01	01	H2041_005_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	330.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	006	0	1	01	01	H2041_006_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	007	0	1	01	01	H2041_007_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2041	008	0	1	01	01	H2041_008_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2041	009	0	1	01	01	H2041_009_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	305.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	010	0	1	01	01	H2041_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2041	011	0	1	01	01	H2041_011_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2041	012	0	1	01	01	H2041_012_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2041	013	0	1	01	01	H2041_013_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2041	014	0	1	01	01	H2041_014_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2041	015	0	1	01	01	H2041_015_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2041	016	0	1	01	01	H2041_016_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2056	003	0	1	02	01	H2056_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2056	005	0	1	02	01	H2056_005_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a $0 Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2056	801	0	1	01	01	H2056_801_0	1	N	N		2																																																																				
H2056	802	0	1	01	01	H2056_802_0	1				1																																																																				
H2064	001	0	1	20	08	H2064_001_0	3				1																																																																				
H2064	002	0	1	20	08	H2064_002_0	3				1																																																																				
H2085	001	0	1	20	08	H2085_001_0	2				1																																																																				
H2085	002	0	1	20	08	H2085_002_0	2				1																																																																				
H2108	022	0	1	01	01	H2108_022_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H2108	029	0	1	01	01	H2108_029_0	6			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	275.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H2108	030	0	1	01	01	H2108_030_0	6			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H2108	036	0	1	01	01	H2108_036_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H2108	041	0	1	01	01	H2108_041_0	6		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H2108	042	1	1	01	01	H2108_042_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H2108	042	2	1	01	01	H2108_042_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H2108	044	0	1	01	01	H2108_044_0	4	N	N		2																																																																				
H2108	045	0	1	01	01	H2108_045_0	4	N	N		2																																																																				
H2108	801	0	1	01	01	H2108_801_0	3				1																																																																				
H2109	001	0	1	20	08	H2109_001_0	2				1																																																																				
H2109	002	0	1	20	08	H2109_002_0	2				1																																																																				
H2117	001	0	1	04	01	H2117_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2117	002	0	1	04	01	H2117_002_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	470.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2117	003	0	1	04	01	H2117_003_0	8	N	N		2																																																																				
H2126	001	0	1	01	01	H2126_001_0	7		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2162	801	0	1	02	01	H2162_801_0	3				1																																																																				
H2168	001	0	1	01	01	H2168_001_0	4		N	5F4	1	4	110110	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				4	1	001		1	3		0111110	3																																		1	1	1	1
H2168	002	0	1	01	01	H2168_002_0	4		N	5F4	1	4	110110	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				4	1	001		1	3		0111110	3																																		1	1	1	1
H2168	004	0	1	01	01	H2168_004_0	4			5F4	1	4	110110	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				4	1	001		1	3		0111110	3																																		1		1	1
H2172	001	0	1	02	01	H2172_001_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	002	0	1	02	01	H2172_002_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	005	0	1	01	01	H2172_005_0	3	N	N		2																																																																				
H2172	008	0	1	02	01	H2172_008_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	009	0	1	02	01	H2172_009_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	010	0	1	02	01	H2172_010_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	013	0	1	02	01	H2172_013_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	014	0	1	02	01	H2172_014_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	150.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	016	0	1	01	01	H2172_016_0	4		N	5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	210.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2172	017	0	1	01	01	H2172_017_0	4		N	5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	295.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2172	018	0	1	01	01	H2172_018_0	4		N	5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	200.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2172	019	0	1	01	01	H2172_019_0	4		N	5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	200.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2172	020	0	1	02	01	H2172_020_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	021	0	1	02	01	H2172_021_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	022	0	1	02	01	H2172_022_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	023	0	1	02	01	H2172_023_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	024	0	1	02	01	H2172_024_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	025	0	1	01	01	H2172_025_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	026	0	1	01	01	H2172_026_0	5			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	027	0	1	02	01	H2172_027_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H2172	801	0	1	01	01	H2172_801_0	2				1																																																																				
H2172	805	0	1	01	01	H2172_805_0	2	N	N		2																																																																				
H2172	806	0	2	01	01	H2172_806_0	2				1																																																																				
H2174	001	0	1	02	01	H2174_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2174	012	0	1	02	01	H2174_012_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2174	013	0	1	02	01	H2174_013_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2185	001	0	1	01	01	H2185_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H2185	003	0	1	02	01	H2185_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	75.00	2	0110000	1				3	1	111	The plan has lowered the deductible to $0 for tiers 1-2 and $75 for tiers 3-5, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H2218	001	0	1	20	08	H2218_001_0	2				1																																																																				
H2218	002	0	1	20	08	H2218_002_0	2				1																																																																				
H2219	001	0	1	20	08	H2219_001_0	5				1																																																																				
H2219	002	0	1	20	08	H2219_002_0	5				1																																																																				
H2220	001	0	1	20	08	H2220_001_0	3				1																																																																				
H2220	002	0	1	20	08	H2220_002_0	3				1																																																																				
H2221	001	0	1	20	08	H2221_001_0	2				1																																																																				
H2221	002	0	1	20	08	H2221_002_0	2				1																																																																				
H2222	002	0	1	20	08	H2222_002_0	2				1																																																																				
H2222	003	0	1	20	08	H2222_003_0	2				1																																																																				
H2223	001	0	1	20	08	H2223_001_0	2				1																																																																				
H2223	002	0	1	20	08	H2223_002_0	2				1																																																																				
H2224	001	0	1	01	01	H2224_001_0	11		N	1	1	4	110110	1	2	2		1	1					Single Tier		2	115.00	1						1	1	010		2	2		0100000	1																																		1		1	1
H2224	003	0	1	01	01	H2224_003_0	9		N		1	1	110110	1		2											615.00																111	31	60	100	01	31		111	31	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2225	001	0	1	01	01	H2225_001_0	6		N		1	1	110110	1		2											615.00																111	31	60	100	01	31		111	31	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2226	001	0	1	01	01	H2226_001_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2226	003	0	1	01	01	H2226_003_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2230	002	0	1	04	01	H2230_002_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	Through the $200 deductible applies only to Tiers 3-5 (which is less than the Defined Standard), flat-dollar copayments on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2230	018	1	1	04	01	H2230_018_1	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Through the $0 deductible, flat-dollar copayments on Tiers 1 and 2, and coinsurances for Tiers 3, 4, and 5 that comply with both CY 2026 Final Part D Bidding Instructions and (in the case of Tier 5) Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value.  The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																		1		1	1
H2230	018	2	1	04	01	H2230_018_2	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Through the $0 deductible, flat-dollar copayments on Tiers 1 and 2, and coinsurances for Tiers 3, 4, and 5 that comply with both CY 2026 Final Part D Bidding Instructions and (in the case of Tier 5) Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value.  The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																		1		1	1
H2230	019	0	1	04	01	H2230_019_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Through the flat-dollar copayments on Tiers 1 and 2, and coinsurances for Tiers 3, 4, and 5 that comply with both Final Part D Bidding Instructions and (in the case of Tier 5) Annual Updates for Part D Specialty Tier Calculation, the actuarial value for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																		1		1	1
H2230	801	0	1	04	01	H2230_801_0	3				1																																																																				
H2230	809	0	1	04	01	H2230_809_0	3	N	N		2																																																																				
H2230	813	0	1	04	01	H2230_813_0	3				1																																																																				
H2235	001	0	1	01	01	H2235_001_0	8			5F	1	4	110110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0111110	1																																		1		1	1
H2235	002	0	1	01	01	H2235_002_0	8			5F	1	4	110110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0111110	1																																		1		1	1
H2235	003	0	1	01	01	H2235_003_0	8			5F	1	4	110110	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0111110	1																																		1		1	1
H2237	007	0	1	01	01	H2237_007_0	3		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2247	001	0	1	02	01	H2247_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2247	003	0	1	02	01	H2247_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2247	004	0	1	01	01	H2247_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2247	005	0	1	01	01	H2247_005_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2256	001	1	1	01	01	H2256_001_1	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	001	2	1	01	01	H2256_001_2	8			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	001	6	1	01	01	H2256_001_6	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	015	1	1	01	01	H2256_015_1	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	015	2	1	01	01	H2256_015_2	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	015	6	1	01	01	H2256_015_6	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	016	1	1	01	01	H2256_016_1	7	N	N		2																																																																				
H2256	016	2	1	01	01	H2256_016_2	7	N	N		2																																																																				
H2256	018	1	1	01	01	H2256_018_1	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	018	7	1	01	01	H2256_018_7	8			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	018	8	1	01	01	H2256_018_8	8			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	019	1	1	01	01	H2256_019_1	7	N	N		2																																																																				
H2256	019	7	1	01	01	H2256_019_7	7	N	N		2																																																																				
H2256	026	1	1	01	01	H2256_026_1	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	026	2	1	01	01	H2256_026_2	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	026	3	1	01	01	H2256_026_3	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	033	0	1	01	01	H2256_033_0	9			5F2	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	034	0	1	01	01	H2256_034_0	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	036	0	1	01	01	H2256_036_0	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	039	0	1	01	01	H2256_039_0	7	N	N		2																																																																				
H2256	040	0	1	01	01	H2256_040_0	7	N	N		2																																																																				
H2256	041	0	1	01	01	H2256_041_0	7	N	N		2																																																																				
H2256	042	0	1	01	01	H2256_042_0	7	N	N		2																																																																				
H2256	046	0	1	01	01	H2256_046_0	9			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H2256	801	0	1	01	01	H2256_801_0	4				1																																																																				
H2256	802	0	1	01	01	H2256_802_0	4	N	N		2																																																																				
H2256	803	0	1	01	01	H2256_803_0	4				1																																																																				
H2256	808	0	1	01	01	H2256_808_0	4	N	N		2																																																																				
H2261	005	0	1	01	01	H2261_005_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	Through the $200 deductible applies only to Tiers 3-5 (which is also less than the Defined Standard), flat-dollar copays on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2261	022	1	1	01	01	H2261_022_1	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	320.00	2	0110000	1				2	1	111	Through the $320 deductible applies only to Tiers 3-5 ( which is less than the Defined Standard), flat-dollar copays on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2261	022	2	1	01	01	H2261_022_2	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	320.00	2	0110000	1				2	1	111	Through the $320 deductible applies only to Tiers 3-5 ( which is less than the Defined Standard), flat-dollar copays on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2261	023	1	1	02	01	H2261_023_1	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	260.00	2	0110000	1				2	1	111	Through the $260 deductible applies only to Tiers 3-5 (which is less than the Defined Standard), flat-dollar copays on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both  Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2261	023	2	1	02	01	H2261_023_2	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	260.00	2	0110000	1				2	1	111	Through the $260 deductible applies only to Tiers 3-5 (which is less than the Defined Standard), flat-dollar copays on Tiers 1-4 that comply with the Final Part D Bidding Instructions, and Tier 5 coinsurance that complies with both  Final Part D Bidding Instructions and Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value. The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																				1	1
H2261	024	0	1	02	01	H2261_024_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Through the $0 deductible, flat-dollar copayments on Tiers 1 and 2, and coinsurances for Tiers 3, 4, and 5 that comply with both Final Part D Bidding Instructions and (in the case of Tier 5) Annual Updates for Part D Specialty Tier Calculation, the actuarial for this plan exceeds the Defined Standard actuarial value.  The BPT shows the actuarial equivalence tests on Worksheet 5, section VI are met.	2	3		0111110	1																																		1		1	1
H2261	801	0	1	01	01	H2261_801_0	3				1																																																																				
H2261	809	0	1	01	01	H2261_809_0	3	N	N		2																																																																				
H2272	001	0	1	02	01	H2272_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H2272	003	0	1	02	01	H2272_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2292	001	0	1	04	01	H2292_001_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2292	002	0	1	04	01	H2292_002_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2293	001	0	1	04	01	H2293_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	002	0	1	04	01	H2293_002_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H2293	004	0	1	04	01	H2293_004_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H2293	009	0	1	04	01	H2293_009_0	2	N	N		2																																																																				
H2293	010	0	1	04	01	H2293_010_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	014	0	1	04	01	H2293_014_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	016	0	1	04	01	H2293_016_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	017	0	1	04	01	H2293_017_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	019	0	1	04	01	H2293_019_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	021	0	1	04	01	H2293_021_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H2293	023	0	1	04	01	H2293_023_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	025	0	1	04	01	H2293_025_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	026	0	1	04	01	H2293_026_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	029	0	1	04	01	H2293_029_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	031	0	1	04	01	H2293_031_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	033	0	1	04	01	H2293_033_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2293	035	0	1	04	01	H2293_035_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2318	001	0	1	20	08	H2318_001_0	2				1																																																																				
H2318	002	0	1	20	08	H2318_002_0	2				1																																																																				
H2320	022	1	1	02	01	H2320_022_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	022	2	1	02	01	H2320_022_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	022	3	1	02	01	H2320_022_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	022	4	1	02	01	H2320_022_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	022	5	1	02	01	H2320_022_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	028	1	1	02	01	H2320_028_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H2320	028	2	1	02	01	H2320_028_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H2320	028	3	1	02	01	H2320_028_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H2320	028	4	1	02	01	H2320_028_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H2320	028	5	1	02	01	H2320_028_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H2320	029	1	1	02	01	H2320_029_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	029	2	1	02	01	H2320_029_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	029	3	1	02	01	H2320_029_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	029	4	1	02	01	H2320_029_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	029	5	1	02	01	H2320_029_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	031	0	1	02	01	H2320_031_0	6			5F	1	2	101101	1		2		5	4	2		1	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
H2320	032	1	1	02	01	H2320_032_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	032	2	1	02	01	H2320_032_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	032	5	1	02	01	H2320_032_5	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H2320	802	0	1	02	01	H2320_802_0	3				1																																																																				
H2320	803	0	1	02	01	H2320_803_0	3				1																																																																				
H2320	804	0	1	01	01	H2320_804_0	3				1																																																																				
H2320	805	0	1	01	01	H2320_805_0	3				1																																																																				
H2320	810	0	1	01	01	H2320_810_0	3	N	N		2																																																																				
H2320	811	0	1	01	01	H2320_811_0	3	N	N		2																																																																				
H2320	812	0	1	02	01	H2320_812_0	3	N	N		2																																																																				
H2320	813	0	1	02	01	H2320_813_0	3	N	N		2																																																																				
H2320	814	0	1	01	01	H2320_814_0	3				1																																																																				
H2320	815	0	1	01	01	H2320_815_0	3				1																																																																				
H2320	816	0	1	01	01	H2320_816_0	3				1																																																																				
H2320	817	0	1	01	01	H2320_817_0	3				1																																																																				
H2322	008	0	1	04	01	H2322_008_0	7			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2322	011	0	1	04	01	H2322_011_0	7			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2322	016	0	1	04	01	H2322_016_0	6			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2322	017	0	1	04	01	H2322_017_0	7			5F	1	2	101101	1		2		5	4	1	2	2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0011110																																			1		1	1
H2322	020	0	1	04	01	H2322_020_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2322	801	0	1	04	01	H2322_801_0	2	N	N		2																																																																				
H2322	803	0	1	04	01	H2322_803_0	2				1																																																																				
H2354	015	0	1	01	01	H2354_015_0	6			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2354	018	0	1	01	01	H2354_018_0	7			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2354	019	0	1	01	01	H2354_019_0	5	N	N		2																																																																				
H2354	021	0	1	02	01	H2354_021_0	7			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2354	025	0	1	01	01	H2354_025_0	7		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2354	028	0	1	01	01	H2354_028_0	6			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2354	029	0	1	01	01	H2354_029_0	7			5F	1	4	101101	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011110	3																																		1		1	1
H2354	030	0	1	01	01	H2354_030_0	7				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2354	801	0	1	01	01	H2354_801_0	2	N	N		2																																																																				
H2354	802	0	1	02	01	H2354_802_0	2				1																																																																				
H2368	001	0	1	20	08	H2368_001_0	2				1																																																																				
H2368	002	0	1	20	08	H2368_002_0	2				1																																																																				
H2384	001	0	1	20	08	H2384_001_0	2				1																																																																				
H2384	002	0	1	20	08	H2384_002_0	2				1																																																																				
H2385	001	0	1	04	01	H2385_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2385	002	0	1	04	01	H2385_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2385	003	0	1	04	01	H2385_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2385	004	0	1	04	01	H2385_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2386	001	0	1	20	08	H2386_001_0	2				1																																																																				
H2386	002	0	1	20	08	H2386_002_0	2				1																																																																				
H2392	001	0	1	01	01	H2392_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2392	003	0	1	01	01	H2392_003_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2397	001	0	1	20	08	H2397_001_0	2				1																																																																				
H2397	002	0	1	20	08	H2397_002_0	2				1																																																																				
H2400	001	0	1	01	01	H2400_001_0	6				1	1	110100	1		2											615.00																111	30	60	90	01	30		000				1	31	2	1	35.00	70.00	105.00				35.00		35.00	25	25	25				25		25			1	1
H2400	002	0	1	01	01	H2400_002_0	5				1	1	110100	1		2											615.00																111	30	60	90	01	30		000				1	31	2	1	35.00	70.00	105.00				35.00		35.00	25	25	25				25		25			1	1
H2406	008	0	1	04	01	H2406_008_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	009	0	1	04	01	H2406_009_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	010	0	1	04	01	H2406_010_0	9			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	011	0	1	04	01	H2406_011_0	9			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	013	0	1	04	01	H2406_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	015	0	1	04	01	H2406_015_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	016	0	1	04	01	H2406_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	017	0	1	04	01	H2406_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	018	0	1	04	01	H2406_018_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	019	0	1	04	01	H2406_019_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	034	0	1	04	01	H2406_034_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	035	0	1	04	01	H2406_035_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	036	0	1	04	01	H2406_036_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	037	0	1	04	01	H2406_037_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	038	0	1	04	01	H2406_038_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	039	0	1	04	01	H2406_039_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	040	0	1	04	01	H2406_040_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	495.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	041	0	1	04	01	H2406_041_0	3	N	N		2																																																																				
H2406	042	0	1	04	01	H2406_042_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	043	0	1	04	01	H2406_043_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	044	0	1	04	01	H2406_044_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	046	0	1	04	01	H2406_046_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	047	0	1	04	01	H2406_047_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	048	0	1	04	01	H2406_048_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	050	0	1	04	01	H2406_050_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	121.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H2406	052	0	1	04	01	H2406_052_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2406	053	0	1	04	01	H2406_053_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2406	054	0	1	04	01	H2406_054_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	055	0	1	04	01	H2406_055_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	056	0	1	04	01	H2406_056_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	058	0	1	04	01	H2406_058_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	059	0	1	04	01	H2406_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	062	0	1	04	01	H2406_062_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	063	0	1	04	01	H2406_063_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	065	0	1	04	01	H2406_065_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	066	0	1	04	01	H2406_066_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	067	0	1	04	01	H2406_067_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	068	0	1	04	01	H2406_068_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	069	0	1	04	01	H2406_069_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	070	0	1	04	01	H2406_070_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	071	0	1	04	01	H2406_071_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	072	0	1	04	01	H2406_072_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	073	0	1	04	01	H2406_073_0	3	N	N		2																																																																				
H2406	074	0	1	04	01	H2406_074_0	3	N	N		2																																																																				
H2406	075	0	1	04	01	H2406_075_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	076	0	1	04	01	H2406_076_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	077	0	1	04	01	H2406_077_0	4	N	N		2																																																																				
H2406	078	0	1	04	01	H2406_078_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	080	0	1	04	01	H2406_080_0	3	N	N		2																																																																				
H2406	082	0	1	04	01	H2406_082_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	087	0	1	04	01	H2406_087_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	088	0	1	04	01	H2406_088_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	089	0	1	04	01	H2406_089_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	090	0	1	04	01	H2406_090_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	091	0	1	04	01	H2406_091_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	092	0	1	04	01	H2406_092_0	3	N	N		2																																																																				
H2406	093	0	1	04	01	H2406_093_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	094	0	1	04	01	H2406_094_0	4	N	N		2																																																																				
H2406	096	0	1	04	01	H2406_096_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	097	0	1	04	01	H2406_097_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	098	0	1	04	01	H2406_098_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	099	0	1	04	01	H2406_099_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2406	100	0	1	04	01	H2406_100_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	101	0	1	04	01	H2406_101_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	104	0	1	04	01	H2406_104_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	110	0	1	04	01	H2406_110_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	112	0	1	04	01	H2406_112_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	113	0	1	04	01	H2406_113_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	115	0	1	04	01	H2406_115_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	119	0	1	04	01	H2406_119_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	121	0	1	04	01	H2406_121_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	465.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	125	0	1	04	01	H2406_125_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	129	0	1	04	01	H2406_129_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2406	130	0	1	04	01	H2406_130_0	3	N	N		2																																																																				
H2406	131	0	1	04	01	H2406_131_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2406	135	0	1	04	01	H2406_135_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2416	001	0	1	01	01	H2416_001_0	7		N		1	1	110110	1		2											615.00																110	31		90	01	31		110	31		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2417	001	0	1	01	01	H2417_001_0	7		N		1	1	110100	1		2											615.00																110	31		93	01	31		000				1	31	1	1	35.00		105.00				35.00		35.00	25		25				25		25			1	1
H2419	001	0	1	01	01	H2419_001_0	4		N		1	1	110100	1		2											615.00																110	30		90	01	30		000				1	31	1	1	35.00		105.00				35.00		35.00	25		25				25		25			1	1
H2422	002	0	1	01	01	H2422_002_0	7		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2425	001	0	1	01	01	H2425_001_0	6		N		1	1	110110	1		2											615.00																110	31		90	01	31		110	31		90	1	31	1	2	35.00		35.00	35.00		35.00	35.00		35.00	25		25	25		25	25		25			1	1
H2441	001	0	1	04	01	H2441_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	520.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2445	001	0	1	02	01	H2445_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2445	002	0	1	02	01	H2445_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2445	003	0	1	02	01	H2445_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2445	004	0	1	02	01	H2445_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2445	005	0	1	02	01	H2445_005_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2450	002	0	1	18	06	H2450_002_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0100000	1				1	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	007	0	1	18	06	H2450_007_0	4			5F	1	3	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						1					3		0001100	1																																		1		1	1
H2450	016	0	1	18	06	H2450_016_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	Plan increases actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	030	0	1	18	06	H2450_030_0	3	N	N		2																																																																				
H2450	032	0	1	18	06	H2450_032_0	3	N	N		2																																																																				
H2450	033	0	1	18	06	H2450_033_0	3	N	N		2																																																																				
H2450	034	0	1	18	06	H2450_034_0	3	N	N		2																																																																				
H2450	035	0	1	18	06	H2450_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	Plan increases actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	036	0	1	18	06	H2450_036_0	3	N	N		2																																																																				
H2450	037	0	1	18	06	H2450_037_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	Plan increases actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	038	0	1	18	06	H2450_038_0	3	N	N		2																																																																				
H2450	039	0	1	18	06	H2450_039_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	Plan increases actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	043	0	1	18	06	H2450_043_0	3	N	N		2																																																																				
H2450	044	0	1	18	06	H2450_044_0	3	N	N		2																																																																				
H2450	046	0	1	18	06	H2450_046_0	3	N	N		2																																																																				
H2450	049	0	1	18	06	H2450_049_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0100000	1				1	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tier 1. Drugs on Tier 1 & 2 use a copayment cost-share structure. Drugs on Tier 3 use coinsurance.	2	3		0001100	1																																		1		1	1
H2450	050	0	1	18	06	H2450_050_0	3	N	N		2																																																																				
H2450	051	0	1	18	06	H2450_051_0	3	N	N		2																																																																				
H2450	801	0	1	18	06	H2450_801_0	2				1																																																																				
H2456	002	0	1	01	01	H2456_002_0	7		N		1	1	110110	1		2											615.00																111	30	60	100	10		29	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	70.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H2458	002	0	1	01	01	H2458_002_0	8		N	5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Plan buys down the supplemental Part D premium with rebate that otherwise would contribute to Part C benefits and margin.	2	3		0001100	1																																		1	1	1	1
H2461	005	0	1	18	06	H2461_005_0	1	N	N		2																																																																				
H2461	006	0	1	18	06	H2461_006_0	2	N	N		2																																																																				
H2461	007	0	1	18	06	H2461_007_0	2	N	N		2																																																																				
H2461	008	0	1	18	06	H2461_008_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
H2461	009	0	1	18	06	H2461_009_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan reduces the member deductible and copays as seen in Rx Cost sharing	2	3		0111100	1																																		1		1	1
H2461	010	0	1	18	06	H2461_010_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan reduces the member deductible and copays as seen in Rx Cost sharing	2	3		0111100	1																																		1		1	1
H2462	026	0	1	18	06	H2462_026_0	5	N	N		2																																																																				
H2462	027	0	1	18	06	H2462_027_0	6	N	N		2																																																																				
H2462	028	0	1	18	06	H2462_028_0	8	N	N		2																																																																				
H2462	801	0	1	18	06	H2462_801_0	1				1																																																																				
H2462	802	0	1	18	06	H2462_802_0	1				1																																																																				
H2463	001	0	1	01	01	H2463_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H2478	001	0	1	01	01	H2478_001_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	575.00	2	0100001	1				1	1	111	Reduced deductible to $575. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H2486	003	0	1	01	01	H2486_003_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H2486	005	0	1	01	01	H2486_005_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H2486	007	0	1	01	01	H2486_007_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H2486	801	0	1	01	01	H2486_801_0	4				1																																																																				
H2486	802	0	1	01	01	H2486_802_0	4	N	N		2																																																																				
H2486	805	0	1	01	01	H2486_805_0	4				1																																																																				
H2486	806	0	1	01	01	H2486_806_0	4	N	N		2																																																																				
H2491	010	0	1	02	01	H2491_010_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	455.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H2491	017	0	1	02	01	H2491_017_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2491	025	0	1	02	01	H2491_025_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H2491	028	0	1	02	01	H2491_028_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2491	029	0	1	02	01	H2491_029_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2491	030	0	1	02	01	H2491_030_0	7	N	N		2																																																																				
H2491	031	0	1	02	01	H2491_031_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2491	032	1	1	02	01	H2491_032_1	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2491	032	2	1	02	01	H2491_032_2	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2491	033	1	1	02	01	H2491_033_1	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	420.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2491	033	2	1	02	01	H2491_033_2	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	420.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2509	001	0	1	02	01	H2509_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2509	002	0	1	02	01	H2509_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	544.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H2509	003	0	1	02	01	H2509_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2526	001	0	1	04	01	H2526_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2526	002	0	1	04	01	H2526_002_0	4	N	N		2																																																																				
H2526	003	0	1	04	01	H2526_003_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2541	001	0	1	20	08	H2541_001_0	2				1																																																																				
H2541	002	0	1	20	08	H2541_002_0	2				1																																																																				
H2563	020	0	1	01	01	H2563_020_0	7		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2564	001	0	1	01	01	H2564_001_0	10		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H2593	001	0	1	02	01	H2593_001_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H2593	003	0	1	01	01	H2593_003_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001101	1																																		1		1	1
H2593	005	0	1	02	01	H2593_005_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H2593	006	0	1	02	01	H2593_006_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H2593	029	0	1	02	01	H2593_029_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H2593	031	0	1	02	01	H2593_031_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H2593	032	0	1	01	01	H2593_032_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	040	0	1	02	01	H2593_040_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H2593	043	0	1	02	01	H2593_043_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	2	3		0001100	1																																		1		1	1
H2593	044	0	1	01	01	H2593_044_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	045	0	1	01	01	H2593_045_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	550.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	046	0	1	01	01	H2593_046_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	205.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	047	0	1	01	01	H2593_047_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	520.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	048	0	1	01	01	H2593_048_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	051	0	1	01	01	H2593_051_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2593	053	0	1	01	01	H2593_053_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	20.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2610	005	0	1	01	01	H2610_005_0	9			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	006	0	1	01	01	H2610_006_0	9			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	015	0	1	01	01	H2610_015_0	8			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers . This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	016	0	1	01	01	H2610_016_0	7			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	021	0	1	01	01	H2610_021_0	8			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	027	0	1	01	01	H2610_027_0	7			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111111	3																																				1	1
H2610	803	0	1	01	01	H2610_803_0	1				1																																																																				
H2610	804	0	1	01	01	H2610_804_0	1				1																																																																				
H2610	805	0	1	01	01	H2610_805_0	1	N	N		2																																																																				
H2610	806	0	1	01	01	H2610_806_0	1	N	N		2																																																																				
H2610	807	0	1	02	01	H2610_807_0	1				1																																																																				
H2610	808	0	1	02	01	H2610_808_0	1				1																																																																				
H2610	809	0	1	02	01	H2610_809_0	1	N	N		2																																																																				
H2610	810	0	1	02	01	H2610_810_0	1	N	N		2																																																																				
H2624	001	0	1	01	01	H2624_001_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0111001	1				3	1	111	This plan charges a deductible that is well below the defined standard deductible.  The deductible only applies to tiers 4 and 5. No copay is applied to tier 6 (insulins).	1	3		0000101	1																																		1		1	1
H2628	001	0	1	01	01	H2628_001_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2628	003	0	1	01	01	H2628_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2628	004	0	1	01	01	H2628_004_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2628	005	0	1	01	01	H2628_005_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2630	001	0	1	01	01	H2630_001_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H2630	002	0	1	01	01	H2630_002_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H2663	005	0	1	02	01	H2663_005_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	006	0	1	02	01	H2663_006_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	017	0	1	02	01	H2663_017_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	021	0	1	02	01	H2663_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	022	0	1	02	01	H2663_022_0	2	N	N		2																																																																				
H2663	023	0	1	02	01	H2663_023_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	025	0	1	02	01	H2663_025_0	2	N	N		2																																																																				
H2663	026	0	1	02	01	H2663_026_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	028	0	1	02	01	H2663_028_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	029	0	1	02	01	H2663_029_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	034	0	1	01	01	H2663_034_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	038	0	1	02	01	H2663_038_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	039	0	1	01	01	H2663_039_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	040	0	1	02	01	H2663_040_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	041	0	1	02	01	H2663_041_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	042	0	1	01	01	H2663_042_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	043	0	1	02	01	H2663_043_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	052	0	1	01	01	H2663_052_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	053	0	1	01	01	H2663_053_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	056	0	1	01	01	H2663_056_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	057	0	1	02	01	H2663_057_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	061	0	1	02	01	H2663_061_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	063	0	1	02	01	H2663_063_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	064	0	1	01	01	H2663_064_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	067	0	1	01	01	H2663_067_0	2			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	069	0	1	02	01	H2663_069_0	2	N	N		2																																																																				
H2663	097	0	1	01	01	H2663_097_0	2		N	5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H2663	098	0	1	01	01	H2663_098_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	099	0	1	01	01	H2663_099_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	100	0	1	01	01	H2663_100_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	102	0	1	01	01	H2663_102_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	103	0	1	02	01	H2663_103_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2663	805	0	1	01	01	H2663_805_0	1	N	N		2																																																																				
H2686	004	1	1	04	01	H2686_004_1	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	004	3	1	04	01	H2686_004_3	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	005	1	1	04	01	H2686_005_1	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	005	2	1	04	01	H2686_005_2	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	006	1	1	04	01	H2686_006_1	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	006	2	1	04	01	H2686_006_2	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	007	0	1	04	01	H2686_007_0	4	N	N		2																																																																				
H2686	008	0	1	04	01	H2686_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	009	0	1	04	01	H2686_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2686	010	0	1	04	01	H2686_010_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2687	001	0	1	01	01	H2687_001_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H2694	001	0	1	04	01	H2694_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	185.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1, 2 and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2694	002	0	1	04	01	H2694_002_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1, 2 and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H2697	001	0	1	01	01	H2697_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	002	0	1	01	01	H2697_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	003	0	1	01	01	H2697_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	004	0	1	01	01	H2697_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	006	0	1	01	01	H2697_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	007	0	1	01	01	H2697_007_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	009	0	1	01	01	H2697_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	010	0	1	01	01	H2697_010_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2697	011	0	1	01	01	H2697_011_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2697	015	0	1	01	01	H2697_015_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	016	0	1	01	01	H2697_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2697	017	0	1	01	01	H2697_017_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2697	018	0	1	01	01	H2697_018_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2697	019	0	1	01	01	H2697_019_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2697	020	0	1	01	01	H2697_020_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2697	022	0	1	01	01	H2697_022_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2704	015	0	1	01	01	H2704_015_0	4		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2704	016	0	1	01	01	H2704_016_0	4		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H2715	003	0	1	01	01	H2715_003_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	There is no deductible.  Cost sharing is reduced on tiers 1, 2 and 6.	2	3		0001110	1																																		1		1	1
H2715	006	1	1	01	01	H2715_006_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H2715	006	2	1	01	01	H2715_006_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H2737	001	0	1	04	01	H2737_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	490.00	2	0110000	1				1	1	011		1	3		0011110	1																																		1		1	1
H2737	801	0	1	04	01	H2737_801_0	3				1																																																																				
H2737	802	0	1	04	01	H2737_802_0	3	N	N		2																																																																				
H2737	803	0	1	04	01	H2737_803_0	3				1																																																																				
H2752	003	0	1	01	01	H2752_003_0	6		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H2775	106	0	1	04	01	H2775_106_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2775	109	0	1	04	01	H2775_109_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2775	111	0	1	04	01	H2775_111_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2775	112	0	1	04	01	H2775_112_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	510.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2775	113	0	1	04	01	H2775_113_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	530.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H2775	115	0	1	04	01	H2775_115_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	380.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2775	116	0	1	04	01	H2775_116_0	8	N	N		2																																																																				
H2802	001	0	1	02	01	H2802_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	007	0	1	02	01	H2802_007_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	008	0	1	02	01	H2802_008_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	010	0	1	02	01	H2802_010_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	012	0	1	02	01	H2802_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	024	0	1	02	01	H2802_024_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	025	0	1	02	01	H2802_025_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	028	0	1	02	01	H2802_028_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	029	0	1	02	01	H2802_029_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	030	0	1	02	01	H2802_030_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	031	0	1	02	01	H2802_031_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	032	0	1	02	01	H2802_032_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	033	0	1	02	01	H2802_033_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	034	0	1	02	01	H2802_034_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	035	0	1	02	01	H2802_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	041	0	1	02	01	H2802_041_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	044	0	1	02	01	H2802_044_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2802	048	0	1	02	01	H2802_048_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	049	0	1	02	01	H2802_049_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	050	0	1	02	01	H2802_050_0	3	N	N		2																																																																				
H2802	052	0	1	02	01	H2802_052_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	053	0	1	02	01	H2802_053_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2802	054	0	1	02	01	H2802_054_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	055	0	1	02	01	H2802_055_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	056	0	1	02	01	H2802_056_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	058	0	1	02	01	H2802_058_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	059	0	1	02	01	H2802_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	060	0	1	02	01	H2802_060_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	061	0	1	02	01	H2802_061_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	062	0	1	02	01	H2802_062_0	3	N	N		2																																																																				
H2802	063	0	1	02	01	H2802_063_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	064	0	1	02	01	H2802_064_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H2802	067	0	1	02	01	H2802_067_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2802	068	0	1	02	01	H2802_068_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	070	0	1	02	01	H2802_070_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	071	0	1	02	01	H2802_071_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	072	0	1	02	01	H2802_072_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	073	0	1	02	01	H2802_073_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	074	0	1	02	01	H2802_074_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	075	0	1	02	01	H2802_075_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	076	0	1	02	01	H2802_076_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	077	0	1	02	01	H2802_077_0	3	N	N		2																																																																				
H2802	078	0	1	02	01	H2802_078_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	079	0	1	02	01	H2802_079_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H2802	801	0	1	01	01	H2802_801_0	1				1																																																																				
H2802	802	0	1	01	01	H2802_802_0	1				1																																																																				
H2802	803	0	1	01	01	H2802_803_0	1	N	N		2																																																																				
H2802	804	0	1	01	01	H2802_804_0	1				1																																																																				
H2802	805	0	1	01	01	H2802_805_0	1	N	N		2																																																																				
H2802	806	0	1	01	01	H2802_806_0	1				1																																																																				
H2802	807	0	1	01	01	H2802_807_0	1				1																																																																				
H2802	808	0	1	01	01	H2802_808_0	1	N	N		2																																																																				
H2802	809	0	1	01	01	H2802_809_0	1				1																																																																				
H2802	816	0	1	01	01	H2802_816_0	1				1																																																																				
H2802	817	0	1	01	01	H2802_817_0	1	N	N		2																																																																				
H2802	818	0	1	01	01	H2802_818_0	1	N	N		2																																																																				
H2802	819	0	1	01	01	H2802_819_0	1				1																																																																				
H2802	820	0	1	01	01	H2802_820_0	1	N	N		2																																																																				
H2802	821	0	1	01	01	H2802_821_0	1	N	N		2																																																																				
H2802	822	0	1	01	01	H2802_822_0	1				1																																																																				
H2802	823	0	1	01	01	H2802_823_0	1				1																																																																				
H2802	824	0	1	01	01	H2802_824_0	1	N	N		2																																																																				
H2815	001	0	1	20	08	H2815_001_0	2				1																																																																				
H2815	002	0	1	20	08	H2815_002_0	2				1																																																																				
H2816	013	0	1	09	04	H2816_013_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2816	019	0	1	09	04	H2816_019_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2816	037	0	1	09	04	H2816_037_0	8	N	N		2																																																																				
H2816	038	0	1	09	04	H2816_038_0	7	N	N		2																																																																				
H2816	040	0	1	09	04	H2816_040_0	8	N	N		2																																																																				
H2819	001	0	1	01	01	H2819_001_0	8		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1	1	1	1
H2835	001	0	1	20	08	H2835_001_0	3				1																																																																				
H2835	002	0	1	20	08	H2835_002_0	3				1																																																																				
H2836	006	0	1	04	01	H2836_006_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2836	007	0	1	04	01	H2836_007_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H2845	001	0	1	04	01	H2845_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2845	002	0	1	04	01	H2845_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2845	003	0	1	04	01	H2845_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H2845	005	0	1	04	01	H2845_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2845	006	0	1	04	01	H2845_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2845	008	0	1	04	01	H2845_008_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2845	009	0	1	04	01	H2845_009_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2845	010	0	1	04	01	H2845_010_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2853	801	0	1	01	01	H2853_801_0	3				1																																																																				
H2875	001	0	1	02	01	H2875_001_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2875	002	0	1	02	01	H2875_002_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2875	003	0	1	01	01	H2875_003_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2875	004	0	1	01	01	H2875_004_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2875	005	0	1	01	01	H2875_005_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2875	006	0	1	02	01	H2875_006_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H2882	003	0	1	20	08	H2882_003_0	2				1																																																																				
H2882	004	0	1	20	08	H2882_004_0	2				1																																																																				
H2915	002	0	1	02	01	H2915_002_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	490.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H2915	003	0	1	02	01	H2915_003_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H2915	011	0	1	02	01	H2915_011_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	475.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H2915	013	0	1	02	01	H2915_013_0	8	N	N		2																																																																				
H2915	018	0	1	02	01	H2915_018_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H2918	001	0	1	20	08	H2918_001_0	2				1																																																																				
H2918	002	0	1	20	08	H2918_002_0	2				1																																																																				
H2923	001	0	1	01	01	H2923_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2923	003	0	1	01	01	H2923_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2923	004	0	1	01	01	H2923_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2923	005	0	1	01	01	H2923_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2923	006	0	1	01	01	H2923_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H2923	009	0	1	01	01	H2923_009_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H2926	001	0	1	01	01	H2926_001_0	6		N		1	1	110110	1		2											615.00																110	31		90	01	31		110	31		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H2936	001	0	1	20	08	H2936_001_0	3				1																																																																				
H2936	002	0	1	20	08	H2936_002_0	3				1																																																																				
H2937	001	0	1	20	08	H2937_001_0	2				1																																																																				
H2937	002	0	1	20	08	H2937_002_0	2				1																																																																				
H2941	001	0	1	20	08	H2941_001_0	3				1																																																																				
H2941	002	0	1	20	08	H2941_002_0	3				1																																																																				
H2942	001	0	1	01	01	H2942_001_0	5			5F3	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								1	1	110	No Rx deductible, no cost share for preferred generic drugs	1	3		0011101	1																																				1	1
H2942	002	0	1	01	01	H2942_002_0	5			5F3	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	400.00	2	0110001	1				1	1	111	Lower Rx deductible, no cost share for preferred generic drugs	1	3		0011101	1																																				1	1
H2942	003	0	1	01	01	H2942_003_0	5			5F3	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	400.00	2	0110001	1				1	1	111	Lower Rx deductible, no cost share for preferred generic drugs	1	3		0011101	1																																				1	1
H2960	009	0	1	01	01	H2960_009_0	3	N	N		2																																																																				
H2960	012	0	1	01	01	H2960_012_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		2	3		0001110	1																																		1		1	1
H2960	018	0	1	01	01	H2960_018_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		2	3		0001110	1																																		1		1	1
H2960	019	0	1	01	01	H2960_019_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		2	3		0001110	1																																		1		1	1
H2960	023	0	1	01	01	H2960_023_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		2	3		0001110	1																																		1		1	1
H2960	024	0	1	01	01	H2960_024_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	87.50	35.00	70.00	70.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2960	026	0	1	01	01	H2960_026_0	4		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	87.50	35.00	70.00	70.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H2960	803	0	1	01	01	H2960_803_0	2				1																																																																				
H2962	001	0	1	01	01	H2962_001_0	13			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4.	1	3		0101010	1																																		1		1	1
H2962	021	0	1	01	01	H2962_021_0	16			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	023	0	1	01	01	H2962_023_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	025	0	1	01	01	H2962_025_0	16			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	026	0	1	01	01	H2962_026_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	028	0	1	01	01	H2962_028_0	13			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4.	1	3		0101010	1																																		1		1	1
H2962	029	0	1	01	01	H2962_029_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	033	0	1	01	01	H2962_033_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	035	0	1	01	01	H2962_035_0	11		N	5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	The plan has lowered the deductible to $0 for some tiers and no cost sharing for tiers 1, 2, and 6.	1	3		0101010	1																																		1	1	1	1
H2962	036	0	1	01	01	H2962_036_0	11		N	5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	The plan has lowered the deductible to $0 for some tiers and no cost sharing for tiers 1, 2, and 6.	1	3		0101010	1																																		1	1	1	1
H2962	045	0	1	01	01	H2962_045_0	13			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4.	1	3		0101010	1																																		1		1	1
H2962	046	0	1	01	01	H2962_046_0	13			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4.	1	3		0101010	1																																		1		1	1
H2962	047	0	1	01	01	H2962_047_0	14			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4.	1	3		0101010	1																																		1		1	1
H2962	050	0	1	01	01	H2962_050_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	051	0	1	01	01	H2962_051_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2962	052	0	1	01	01	H2962_052_0	14			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3/4/6.	1	3		0101011	1																																		1		1	1
H2992	001	0	1	20	08	H2992_001_0	2				1																																																																				
H2992	002	0	1	20	08	H2992_002_0	2				1																																																																				
H2992	003	0	1	20	08	H2992_003_0	2				1																																																																				
H2992	004	0	1	20	08	H2992_004_0	2				1																																																																				
H3038	002	0	1	01	01	H3038_002_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3038	004	1	1	01	01	H3038_004_1	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3038	004	2	1	01	01	H3038_004_2	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3038	004	3	1	01	01	H3038_004_3	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3038	004	4	1	01	01	H3038_004_4	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3041	001	0	1	01	01	H3041_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3041	003	0	1	01	01	H3041_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3048	001	0	1	01	01	H3048_001_0	10				1	1	110100	1		2											615.00																111	30	60	90	01	30		000				1	31	2	2	35.00	70.00	105.00				35.00		35.00	20	20	20				20		20			1	1
H3048	002	0	1	01	01	H3048_002_0	11				1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H3048	003	0	1	01	01	H3048_003_0	12			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		2	3		0111110	1																																		1		1	1
H3060	001	0	1	20	08	H3060_001_0	2				1																																																																				
H3060	002	0	1	20	08	H3060_002_0	2				1																																																																				
H3071	002	0	1	01	01	H3071_002_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H3080	001	0	1	01	01	H3080_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3080	002	0	1	01	01	H3080_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3080	003	0	1	01	01	H3080_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H3080	004	0	1	01	01	H3080_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H3080	006	0	1	01	01	H3080_006_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H3080	007	0	1	01	01	H3080_007_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H3084	001	0	1	20	08	H3084_001_0	2				1																																																																				
H3084	002	0	1	20	08	H3084_002_0	2				1																																																																				
H3093	001	0	1	01	01	H3093_001_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2, and 6.	2	3		0001110	1																																		1	1	1	1
H3093	002	0	1	01	01	H3093_002_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2, and 6.	2	3		0001110	1																																		1	1	1	1
H3093	003	0	1	01	01	H3093_003_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0100001	1				1	1	111	Reduced deductible to $100. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible does not apply to Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3093	004	0	1	01	01	H3093_004_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	Reduced deductible to $0. Reduced cost share on Tiers 1, 2, 3, and 6.	2	3		0001110	1																																		1	1	1	1
H3093	005	0	1	01	01	H3093_005_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H3113	005	0	1	01	01	H3113_005_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H3113	009	0	1	02	01	H3113_009_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3113	010	0	1	02	01	H3113_010_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3113	014	0	1	02	01	H3113_014_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3113	016	0	1	02	01	H3113_016_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3124	001	0	1	04	01	H3124_001_0	19			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan does not charge members a Part D deductible and offers competitive lower cost share at all tiers	2	3		0001110	1																																		1		1	1
H3124	002	0	1	04	01	H3124_002_0	19			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan does not charge members a Part D deductible and offers competitive lower cost share at all tiers	2	3		0001110	1																																		1		1	1
H3127	001	0	1	01	01	H3127_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3138	001	0	1	04	01	H3138_001_0	6			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H3138	002	0	1	04	01	H3138_002_0	6			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H3138	003	0	1	04	01	H3138_003_0	6			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H3146	001	0	1	01	01	H3146_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	002	0	1	01	01	H3146_002_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3146	004	0	1	01	01	H3146_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	006	0	1	01	01	H3146_006_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	007	0	1	01	01	H3146_007_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	011	0	1	01	01	H3146_011_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	012	0	1	01	01	H3146_012_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	014	0	1	01	01	H3146_014_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	016	0	1	01	01	H3146_016_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3146	021	0	1	01	01	H3146_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	022	0	1	01	01	H3146_022_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3146	023	0	1	01	01	H3146_023_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3146	036	0	1	01	01	H3146_036_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	037	0	1	01	01	H3146_037_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	038	0	1	01	01	H3146_038_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	039	0	1	01	01	H3146_039_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	040	0	1	01	01	H3146_040_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	041	0	1	01	01	H3146_041_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	044	0	1	01	01	H3146_044_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	046	0	1	01	01	H3146_046_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	047	0	1	01	01	H3146_047_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3146	801	0	1	01	01	H3146_801_0	1	N	N		2																																																																				
H3152	022	0	1	02	01	H3152_022_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3152	045	0	1	01	01	H3152_045_0	3	N	N		2																																																																				
H3152	048	0	1	01	01	H3152_048_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3152	080	0	1	02	01	H3152_080_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3152	082	0	1	01	01	H3152_082_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3152	098	0	1	01	01	H3152_098_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3152	801	0	1	01	01	H3152_801_0	1	N	N		2																																																																				
H3152	804	0	1	01	01	H3152_804_0	1				1																																																																				
H3170	003	1	1	01	01	H3170_003_1	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				2	1	111	There is no deductible on tiers 1-3 and cost shares have been reduced, including as low as $0 on tiers 1 and 2.	1	3		0111100	1																																				1	1
H3170	003	2	1	01	01	H3170_003_2	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				2	1	111	There is no deductible on tiers 1-3 and cost shares have been reduced, including as low as $0 on tiers 1 and 2.	1	3		0111100	1																																				1	1
H3186	001	0	1	04	01	H3186_001_0	5			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H3186	002	0	1	04	01	H3186_002_0	5			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H3192	001	0	1	02	01	H3192_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	003	0	1	02	01	H3192_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	005	0	1	02	01	H3192_005_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	007	0	1	01	01	H3192_007_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3192	010	0	1	02	01	H3192_010_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	013	0	1	02	01	H3192_013_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	020	0	1	02	01	H3192_020_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	021	0	1	02	01	H3192_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	028	0	1	01	01	H3192_028_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	029	0	1	01	01	H3192_029_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	033	0	1	01	01	H3192_033_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3192	801	0	1	01	01	H3192_801_0	1	N	N		2																																																																				
H3204	001	0	1	01	01	H3204_001_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001100	1																																		1		1	1
H3204	007	0	1	01	01	H3204_007_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001100	1																																		1		1	1
H3204	008	0	1	01	01	H3204_008_0	3	N	N		2																																																																				
H3204	013	4	1	01	01	H3204_013_4	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0100000	1				1	1	111	The actuarial value of the enhanced cost sharing is higher than under defined standard.	2	3		0001100	1																																		1	1	1	1
H3204	013	5	1	01	01	H3204_013_5	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0100000	1				1	1	111	The actuarial value of the enhanced cost sharing is higher than under defined standard.	2	3		0001100	1																																		1	1	1	1
H3204	013	6	1	01	01	H3204_013_6	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0100000	1				1	1	111	The actuarial value of the enhanced cost sharing is higher than under defined standard.	2	3		0001100	1																																		1	1	1	1
H3204	017	0	1	01	01	H3204_017_0	6				1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3204	801	0	1	01	01	H3204_801_0	1				1																																																																				
H3204	802	0	1	01	01	H3204_802_0	1	N	N		2																																																																				
H3204	803	0	1	01	01	H3204_803_0	1				1																																																																				
H3204	808	0	1	02	01	H3204_808_0	1				1																																																																				
H3204	809	0	1	02	01	H3204_809_0	1	N	N		2																																																																				
H3204	810	0	1	02	01	H3204_810_0	1				1																																																																				
H3219	001	0	1	04	01	H3219_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	002	0	1	04	01	H3219_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	003	0	1	04	01	H3219_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	004	0	1	04	01	H3219_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a $0 Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	005	0	1	04	01	H3219_005_0	2	N	N		2																																																																				
H3219	008	0	1	04	01	H3219_008_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	012	0	1	04	01	H3219_012_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	014	0	1	04	01	H3219_014_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	015	0	1	04	01	H3219_015_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	016	0	1	04	01	H3219_016_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3219	801	0	1	04	01	H3219_801_0	1	N	N		2																																																																				
H3239	001	0	1	01	01	H3239_001_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	002	0	1	01	01	H3239_002_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	005	0	1	01	01	H3239_005_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	007	0	1	01	01	H3239_007_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	010	0	1	01	01	H3239_010_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	012	0	1	01	01	H3239_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	014	0	1	01	01	H3239_014_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3239	015	0	1	01	01	H3239_015_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	017	0	1	01	01	H3239_017_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3239	020	0	1	01	01	H3239_020_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3239	022	0	1	01	01	H3239_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3239	023	0	1	01	01	H3239_023_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	026	0	1	01	01	H3239_026_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	027	0	1	01	01	H3239_027_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	028	0	1	01	01	H3239_028_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3239	030	0	1	01	01	H3239_030_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3240	013	0	1	01	01	H3240_013_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	1						2	1	100	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H3240	017	0	1	02	01	H3240_017_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3240	024	0	1	02	01	H3240_024_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	1						2	1	100	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H3251	002	0	1	01	01	H3251_002_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3251	029	0	1	01	01	H3251_029_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3251	804	0	1	01	01	H3251_804_0	2				1																																																																				
H3256	004	1	1	04	01	H3256_004_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3256	004	2	1	04	01	H3256_004_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3256	005	1	1	04	01	H3256_005_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3256	005	2	1	04	01	H3256_005_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3256	006	1	1	04	01	H3256_006_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3256	006	2	1	04	01	H3256_006_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3259	001	0	1	01	01	H3259_001_0	11		N	4E	1	4	110110	1	2	2		4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				4	1	101	Tier 1: waived deductible and $0 copay during initial coverage phase.	2	3		0011000	1																																		1	1	1	1
H3259	002	0	1	01	01	H3259_002_0	12		N	4E	1	4	110110	1	2	2		4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				4	1	101	Tier 1: waived deductible and $0 copay during initial coverage phase.	2	3		0011000	1																																		1	1	1	1
H3259	003	0	1	01	01	H3259_003_0	11		N	4E	1	4	110110	1	2	2		4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				4	1	101	Tier 1: waived deductible and $0 copay during initial coverage phase.	2	3		0011000	1																																		1	1	1	1
H3274	001	0	1	01	01	H3274_001_0	5				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	1	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3274	002	0	1	01	01	H3274_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	The plan has lowered the deductible to $0 for all medication tiers, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3274	005	0	1	01	01	H3274_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	The plan has lowered the deductible to $0 for all medication tiers, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3276	001	0	1	02	01	H3276_001_0	13		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H3284	001	0	1	20	08	H3284_001_0	2				1																																																																				
H3284	002	0	1	20	08	H3284_002_0	2				1																																																																				
H3288	001	0	1	04	01	H3288_001_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	002	0	1	04	01	H3288_002_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	003	0	1	04	01	H3288_003_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	004	0	1	04	01	H3288_004_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	005	0	1	04	01	H3288_005_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	006	0	1	04	01	H3288_006_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	007	0	1	04	01	H3288_007_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	008	0	1	04	01	H3288_008_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	009	0	1	04	01	H3288_009_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	011	0	1	04	01	H3288_011_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	016	0	1	04	01	H3288_016_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	017	0	1	04	01	H3288_017_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	018	0	1	04	01	H3288_018_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	019	0	1	04	01	H3288_019_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	020	0	1	04	01	H3288_020_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	021	0	1	04	01	H3288_021_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	027	0	1	04	01	H3288_027_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	034	0	1	04	01	H3288_034_0	2	N	N		2																																																																				
H3288	042	0	1	04	01	H3288_042_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	046	0	1	04	01	H3288_046_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	047	0	1	04	01	H3288_047_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	048	0	1	04	01	H3288_048_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3288	051	0	1	04	01	H3288_051_0	3	N	N		2																																																																				
H3288	053	0	1	04	01	H3288_053_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3288	801	0	1	04	01	H3288_801_0	1	N	N		2																																																																				
H3291	001	0	1	01	01	H3291_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H3291	002	0	1	01	01	H3291_002_0	4		N		1	1	110110	1		2											615.00																111	30	60	90	10		10	101		60	90	1	31	2	2	35.00	70.00	105.00		70.00	105.00		35.00	35.00	25	25	25		25	25		25	25			1	1
H3291	003	0	1	01	01	H3291_003_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all Tiers.  This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H3305	007	0	1	02	01	H3305_007_0	8	N	N		2																																																																				
H3305	015	0	1	02	01	H3305_015_0	17			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				2	1	111	The plan has lowered the deductible to $0 for tier 1 and $300 for tiers 2/3/4/5 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H3305	020	0	1	02	01	H3305_020_0	8	N	N		2																																																																				
H3305	022	0	1	02	01	H3305_022_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0100000	1				2	1	111	The plan has lowered the deductible to $0 for tier 1 and $400 for tiers 2/3/4/5 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H3305	033	0	1	01	01	H3305_033_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan has lowered the deductible to $0 and reduced cost sharing via copays to $0 in the coverage phase for tier 6.	2	3		0111111	1																																		1	1	1	1
H3305	034	0	1	01	01	H3305_034_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan has lowered the deductible to $0 and reduced cost sharing via copays to $0 in the coverage phase for tier 6.	2	3		0111111	1																																		1	1	1	1
H3305	801	0	1	02	01	H3305_801_0	7	N	N		2																																																																				
H3305	803	0	1	02	01	H3305_803_0	7				1																																																																				
H3305	804	0	1	02	01	H3305_804_0	7				1																																																																				
H3312	002	0	1	01	01	H3312_002_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	018	0	1	02	01	H3312_018_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	048	0	1	01	01	H3312_048_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	062	0	1	01	01	H3312_062_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	064	0	1	01	01	H3312_064_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	065	0	1	02	01	H3312_065_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	069	0	1	01	01	H3312_069_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3312	070	0	1	01	01	H3312_070_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3312	073	0	1	01	01	H3312_073_0	3		N		1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3312	074	0	1	01	01	H3312_074_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	081	0	1	01	01	H3312_081_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	082	0	1	01	01	H3312_082_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	087	0	1	01	01	H3312_087_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3312	089	0	1	01	01	H3312_089_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3312	090	0	1	01	01	H3312_090_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3312	091	0	1	01	01	H3312_091_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	097	0	1	01	01	H3312_097_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3312	801	0	1	01	01	H3312_801_0	1	N	N		2																																																																				
H3312	804	0	1	01	01	H3312_804_0	1				1																																																																				
H3321	001	0	1	20	08	H3321_001_0	2				1																																																																				
H3321	003	0	1	20	08	H3321_003_0	2				1																																																																				
H3322	001	0	1	20	08	H3322_001_0	2				1																																																																				
H3322	002	0	1	20	08	H3322_002_0	2				1																																																																				
H3329	001	0	1	20	08	H3329_001_0	2				1																																																																				
H3329	002	0	1	20	08	H3329_002_0	2				1																																																																				
H3330	021	2	1	01	01	H3330_021_2	6			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	The Enhanced Alternative plan fulfills the requirement to increase the actuarial value of benefits compared to the Defined Standard by reducing the member’s deductible and member’s cost share within the initial coverage phase. The richness of the Enhanced Alternative plan is confirmed through passing all required actuarial equivalence tests in worksheet 5 of the Part D BPT.	2	3		0001100	1																																		1		1	1
H3330	021	3	1	01	01	H3330_021_3	6			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	The Enhanced Alternative plan fulfills the requirement to increase the actuarial value of benefits compared to the Defined Standard by reducing the member’s deductible and member’s cost share within the initial coverage phase. The richness of the Enhanced Alternative plan is confirmed through passing all required actuarial equivalence tests in worksheet 5 of the Part D BPT.	2	3		0001100	1																																		1		1	1
H3330	021	5	1	01	01	H3330_021_5	6			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	The Enhanced Alternative plan fulfills the requirement to increase the actuarial value of benefits compared to the Defined Standard by reducing the member’s deductible and member’s cost share within the initial coverage phase. The richness of the Enhanced Alternative plan is confirmed through passing all required actuarial equivalence tests in worksheet 5 of the Part D BPT.	2	3		0001100	1																																		1		1	1
H3330	038	0	1	01	01	H3330_038_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	The Enhanced Alternative plan fulfills the requirement to increase the actuarial value of benefits compared to the Defined Standard by reducing the member’s deductible and member’s cost share within the initial coverage phase. The richness of the Enhanced Alternative plan is confirmed through passing all required actuarial equivalence tests in worksheet 5 of the Part D BPT.	2	3		0001100	1																																		1		1	1
H3330	048	0	1	02	01	H3330_048_0	7			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	215.00	2	0110001	1				2	1	111	The Enhanced Alternative plan fulfills the requirement to increase the actuarial value of benefits compared to the Defined Standard by reducing the member’s deductible and member’s cost share within the initial coverage phase. The richness of the Enhanced Alternative plan is confirmed through passing all required actuarial equivalence tests in worksheet 5 of the Part D BPT.	2	3		0001100	1																																		1		1	1
H3330	814	0	1	01	01	H3330_814_0	2				1																																																																				
H3330	815	0	1	01	01	H3330_815_0	2	N	N		2																																																																				
H3330	820	0	1	02	01	H3330_820_0	2				1																																																																				
H3330	821	0	1	02	01	H3330_821_0	2	N	N		2																																																																				
H3331	001	0	1	20	08	H3331_001_0	3				1																																																																				
H3331	002	0	1	20	08	H3331_002_0	3				1																																																																				
H3335	015	0	1	04	01	H3335_015_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3335	018	0	1	04	01	H3335_018_0	8			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2					3		0111110	1																																		1		1	1
H3335	038	0	1	04	01	H3335_038_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3335	043	0	1	04	01	H3335_043_0	7	N	N		2																																																																				
H3335	044	0	1	04	01	H3335_044_0	7	N	N		2																																																																				
H3335	053	0	1	04	01	H3335_053_0	8			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3335	055	0	1	04	01	H3335_055_0	8			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3335	060	0	1	04	01	H3335_060_0	8			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3335	061	0	1	04	01	H3335_061_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3335	062	0	1	04	01	H3335_062_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3335	801	0	1	04	01	H3335_801_0	4				1																																																																				
H3335	811	0	1	04	01	H3335_811_0	4				1																																																																				
H3335	813	0	1	04	01	H3335_813_0	4	N	N		2																																																																				
H3335	819	0	1	04	01	H3335_819_0	4	N	N		2																																																																				
H3335	820	0	1	04	01	H3335_820_0	5				1																																																																				
H3335	822	0	1	04	01	H3335_822_0	5				1																																																																				
H3335	824	0	1	04	01	H3335_824_0	4				1																																																																				
H3335	825	0	1	04	01	H3335_825_0	4	N	N		2																																																																				
H3344	013	0	1	04	01	H3344_013_0	7				1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	34	2	2	35.00		87.50			87.50	35.00		35.00	25		25			25	25		25			1	1
H3344	801	0	1	04	01	H3344_801_0	4				1																																																																				
H3344	804	0	1	04	01	H3344_804_0	4	N	N		2																																																																				
H3344	805	0	1	04	01	H3344_805_0	4				1																																																																				
H3347	002	0	1	02	01	H3347_002_0	8		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			70.00	35.00		35.00	25	25	25			25	25		25			1	1
H3347	003	0	1	02	01	H3347_003_0	8				1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			70.00	35.00		35.00	25	25	25			25	25		25			1	1
H3347	007	0	1	02	01	H3347_007_0	9		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			70.00	35.00		35.00	25	25	25			25	25		25			1	1
H3347	009	0	1	02	01	H3347_009_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0111000	1				1	1	111	we’re reducing the deductible and/or not applying the deductible on all tiers. Also, the cost sharing structure of the copays has a higher actuarial value than the defined standard 25% coinsurance.	2	3		0111110	1																																				1	1
H3347	016	0	1	02	01	H3347_016_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0111000	1				1	1	111	we’re reducing the deductible and/or not applying the deductible on all tiers. Also, the cost sharing structure of the copays has a higher actuarial value than the defined standard 25% coinsurance.	2	3		0111110	1																																				1	1
H3347	018	0	1	02	01	H3347_018_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	we’re reducing the deductible and/or not applying the deductible on all tiers. Also, the cost sharing structure of the copays has a higher actuarial value than the defined standard 25% coinsurance.	2	3		0111110	1																																				1	1
H3351	001	0	1	02	01	H3351_001_0	6	N	N		2																																																																				
H3351	002	0	1	02	01	H3351_002_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3351	006	0	1	02	01	H3351_006_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3351	007	0	1	02	01	H3351_007_0	7	N	N		2																																																																				
H3351	012	0	1	02	01	H3351_012_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3351	017	0	1	01	01	H3351_017_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3351	019	0	1	02	01	H3351_019_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	2	3		0111110	1																																		1		1	1
H3351	020	0	1	01	01	H3351_020_0	6			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3351	022	0	1	01	01	H3351_022_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3351	023	0	1	01	01	H3351_023_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
H3351	801	0	1	02	01	H3351_801_0	4				1																																																																				
H3351	802	0	1	02	01	H3351_802_0	4				1																																																																				
H3351	803	0	1	02	01	H3351_803_0	4	N	N		2																																																																				
H3351	804	0	1	02	01	H3351_804_0	4	N	N		2																																																																				
H3351	805	0	1	02	01	H3351_805_0	4				1																																																																				
H3351	806	0	1	02	01	H3351_806_0	4				1																																																																				
H3359	001	0	1	01	01	H3359_001_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	1	3		0111110	3																																		1		1	1
H3359	019	0	1	01	01	H3359_019_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	1	3		0111110	3																																		1		1	1
H3359	021	0	1	01	01	H3359_021_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	2	3		0111110	1																																		1	1	1	1
H3359	034	0	1	01	01	H3359_034_0	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3359	038	0	1	01	01	H3359_038_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	2	3		0111110	1																																		1	1	1	1
H3359	808	0	1	01	01	H3359_808_0	1				1																																																																				
H3359	809	0	1	01	01	H3359_809_0	1	N	N		2																																																																				
H3362	016	0	1	01	01	H3362_016_0	6	N	N		2																																																																				
H3362	020	0	1	01	01	H3362_020_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111100	3																																		1		1	1
H3362	040	0	1	01	01	H3362_040_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	50.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111100	3																																		1		1	1
H3362	042	0	1	01	01	H3362_042_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3362	043	0	1	01	01	H3362_043_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	50.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111100	3																																		1		1	1
H3362	044	0	1	01	01	H3362_044_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3362	801	0	1	01	01	H3362_801_0	4				1																																																																				
H3362	807	0	1	02	01	H3362_807_0	4				1																																																																				
H3362	819	0	1	02	01	H3362_819_0	4	N	N		2																																																																				
H3362	820	0	1	01	01	H3362_820_0	4	N	N		2																																																																				
H3379	001	0	1	02	01	H3379_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	039	0	1	02	01	H3379_039_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	040	0	1	02	01	H3379_040_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	043	0	1	02	01	H3379_043_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	052	0	1	02	01	H3379_052_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	053	0	1	02	01	H3379_053_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	054	0	1	02	01	H3379_054_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	056	0	1	02	01	H3379_056_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	059	0	1	02	01	H3379_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3379	060	0	1	02	01	H3379_060_0	3	N	N		2																																																																				
H3379	802	0	1	01	01	H3379_802_0	1				1																																																																				
H3379	803	0	1	01	01	H3379_803_0	1	N	N		2																																																																				
H3379	804	0	1	01	01	H3379_804_0	1				1																																																																				
H3384	013	0	1	01	01	H3384_013_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	019	0	1	01	01	H3384_019_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	022	0	1	01	01	H3384_022_0	4	N	N		2																																																																				
H3384	069	1	1	01	01	H3384_069_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	069	2	1	01	01	H3384_069_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	069	3	1	01	01	H3384_069_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	070	1	1	01	01	H3384_070_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	070	2	1	01	01	H3384_070_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	070	3	1	01	01	H3384_070_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	071	0	1	01	01	H3384_071_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3384	805	0	1	01	01	H3384_805_0	1	N	N		2																																																																				
H3384	806	0	1	01	01	H3384_806_0	1				1																																																																				
H3384	811	0	1	02	01	H3384_811_0	1				1																																																																				
H3384	812	0	1	02	01	H3384_812_0	1	N	N		2																																																																				
H3384	813	0	1	01	01	H3384_813_0	1				1																																																																				
H3387	013	0	1	02	01	H3387_013_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3387	014	1	1	02	01	H3387_014_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3387	014	2	1	02	01	H3387_014_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3387	015	1	1	02	01	H3387_015_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3387	015	2	1	02	01	H3387_015_2	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3387	017	0	1	02	01	H3387_017_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3388	001	0	1	01	01	H3388_001_0	2	N	N		2																																																																				
H3388	002	0	1	01	01	H3388_002_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Reduced deductible and elimination of cost share tiers.	2	3		0001100	1																																		1		1	1
H3388	014	0	1	01	01	H3388_014_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	Reduced deductible and elimination of cost shares.	2	3		0001100	1																																		1		1	1
H3388	020	0	1	01	01	H3388_020_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0111000	1				2	1	111	Reduced deductible and elimination of cost share	2	3		0001100	1																																		1		1	1
H3388	801	0	1	01	01	H3388_801_0	3				1																																																																				
H3388	803	0	1	01	01	H3388_803_0	3				1																																																																				
H3388	804	0	1	01	01	H3388_804_0	4	N	N		2																																																																				
H3404	003	1	1	04	01	H3404_003_1	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3404	003	2	1	04	01	H3404_003_2	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3404	004	0	1	04	01	H3404_004_0	8	N	N		2																																																																				
H3404	801	0	1	04	01	H3404_801_0	6	N	N		2																																																																				
H3404	810	0	1	04	01	H3404_810_0	6				1																																																																				
H3404	811	0	1	04	01	H3404_811_0	6				1																																																																				
H3407	001	0	1	01	01	H3407_001_0	8		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0000001	1				3	1	001		1	3		0001100	3																																		1	1	1	1
H3407	002	0	1	01	01	H3407_002_0	8			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		2	425.00	2	0110001	1				3	1	011		1	3		0001100	3																																		1		1	1
H3407	003	0	1	01	01	H3407_003_0	7			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				3	1	001		1	3		0001100	3																																		1		1	1
H3418	001	0	1	04	01	H3418_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3418	002	0	1	04	01	H3418_002_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3418	004	0	1	04	01	H3418_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3418	008	0	1	04	01	H3418_008_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3419	001	0	1	01	01	H3419_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3419	003	0	1	02	01	H3419_003_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	The plan has lowered the deductible to $0 for all medication tiers, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3419	004	0	1	02	01	H3419_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	The plan has lowered the deductible to $0 for all medication tiers, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3419	005	0	1	01	01	H3419_005_0	5				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3419	006	0	1	01	01	H3419_006_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				3	1	111	This plan has lowered the deductible to $0 for medication tiers 1-2 and $400 for tiers 3-5, and reduced copay cost-share tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3419	007	0	1	01	01	H3419_007_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				3	1	111	The plan has lowered the deductible to $0 for medication tiers 1-2 and $400 for tiers 3-5, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H3430	001	0	1	20	08	H3430_001_0	2				1																																																																				
H3430	002	0	1	20	08	H3430_002_0	2				1																																																																				
H3443	001	0	1	01	01	H3443_001_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3443	002	0	1	01	01	H3443_002_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3443	003	0	1	01	01	H3443_003_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3443	005	0	1	01	01	H3443_005_0	11			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111101	1				2	1	101	This PBP's design increase the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H3443	006	0	1	01	01	H3443_006_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3443	007	0	1	01	01	H3443_007_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3443	801	0	1	01	01	H3443_801_0	1				1																																																																				
H3443	802	0	1	01	01	H3443_802_0	1				1																																																																				
H3443	803	0	1	01	01	H3443_803_0	1	N	N		2																																																																				
H3443	804	0	1	01	01	H3443_804_0	1	N	N		2																																																																				
H3447	013	0	1	02	01	H3447_013_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H3447	018	0	1	01	01	H3447_018_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H3447	024	0	1	02	01	H3447_024_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	390.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1		1	1
H3447	025	0	1	02	01	H3447_025_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H3447	033	0	1	02	01	H3447_033_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	325.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H3447	037	0	1	02	01	H3447_037_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	295.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H3447	038	1	1	02	01	H3447_038_1	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	210.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	038	2	1	02	01	H3447_038_2	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	210.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	039	0	1	02	01	H3447_039_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H3447	042	1	1	02	01	H3447_042_1	7			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	042	2	1	02	01	H3447_042_2	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	042	3	1	02	01	H3447_042_3	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	042	4	1	02	01	H3447_042_4	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	049	0	1	02	01	H3447_049_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	050	0	1	02	01	H3447_050_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	051	0	1	02	01	H3447_051_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	052	0	1	02	01	H3447_052_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	220.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	053	0	1	01	01	H3447_053_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H3447	056	0	1	02	01	H3447_056_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3447	804	0	1	01	01	H3447_804_0	3				1																																																																				
H3447	805	0	1	01	01	H3447_805_0	3	N	N		2																																																																				
H3447	806	0	2	01	01	H3447_806_0	3				1																																																																				
H3447	807	0	2	01	01	H3447_807_0	3	N	N		2																																																																				
H3447	809	0	1	01	01	H3447_809_0	3	N	N		2																																																																				
H3447	811	0	1	01	01	H3447_811_0	3				1																																																																				
H3447	812	0	1	01	01	H3447_812_0	3	N	N		2																																																																				
H3447	813	0	2	01	01	H3447_813_0	3				1																																																																				
H3447	814	0	2	01	01	H3447_814_0	3	N	N		2																																																																				
H3447	816	0	1	01	01	H3447_816_0	3	N	N		2																																																																				
H3447	818	0	1	01	01	H3447_818_0	4				1																																																																				
H3447	819	0	1	01	01	H3447_819_0	3	N	N		2																																																																				
H3447	820	0	2	01	01	H3447_820_0	3				1																																																																				
H3447	821	0	2	01	01	H3447_821_0	3	N	N		2																																																																				
H3447	823	0	1	01	01	H3447_823_0	4	N	N		2																																																																				
H3447	825	0	2	01	01	H3447_825_0	3	N	N		2																																																																				
H3447	826	0	2	01	01	H3447_826_0	4	N	N		2																																																																				
H3447	827	0	2	01	01	H3447_827_0	3	N	N		2																																																																				
H3449	012	0	1	02	01	H3449_012_0	8	N	N		2																																																																				
H3449	023	1	1	02	01	H3449_023_1	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	023	2	1	02	01	H3449_023_2	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	023	4	1	02	01	H3449_023_4	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	023	5	1	02	01	H3449_023_5	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	024	1	1	02	01	H3449_024_1	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	024	2	1	02	01	H3449_024_2	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	024	3	1	02	01	H3449_024_3	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	026	0	1	01	01	H3449_026_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	027	1	1	01	01	H3449_027_1	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	027	2	1	01	01	H3449_027_2	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
H3449	805	0	1	01	01	H3449_805_0	6	N	N		2																																																																				
H3449	814	0	1	01	01	H3449_814_0	6				1																																																																				
H3449	815	0	1	01	01	H3449_815_0	6				1																																																																				
H3467	001	0	1	02	01	H3467_001_0	7				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H3467	002	0	1	02	01	H3467_002_0	5				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3467	005	0	1	02	01	H3467_005_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H3473	001	0	1	20	08	H3473_001_0	2				1																																																																				
H3473	002	0	1	20	08	H3473_002_0	2				1																																																																				
H3493	001	0	1	20	08	H3493_001_0	2				1																																																																				
H3493	002	0	1	20	08	H3493_002_0	2				1																																																																				
H3499	002	0	1	02	01	H3499_002_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H3499	008	0	1	02	01	H3499_008_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	560.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H3517	001	0	1	20	08	H3517_001_0	2				1																																																																				
H3517	002	0	1	20	08	H3517_002_0	2				1																																																																				
H3522	001	0	1	20	08	H3522_001_0	2				1																																																																				
H3522	002	0	1	20	08	H3522_002_0	2				1																																																																				
H3528	003	0	1	02	01	H3528_003_0	10	N	N		2																																																																				
H3528	010	0	1	02	01	H3528_010_0	13			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3528	011	1	1	02	01	H3528_011_1	13			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	185.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3528	011	2	1	02	01	H3528_011_2	13			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	185.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3528	014	0	1	02	01	H3528_014_0	13			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3528	015	0	1	02	01	H3528_015_0	13			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3528	016	0	1	02	01	H3528_016_0	14			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0100001	1				1	1	111	Reduced deductible. Reduced cost share on Tiers 1, 2, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H3533	002	0	1	01	01	H3533_002_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H3533	027	0	1	01	01	H3533_027_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H3533	033	0	1	01	01	H3533_033_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H3533	034	1	1	01	01	H3533_034_1	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H3533	034	2	1	01	01	H3533_034_2	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H3533	035	0	1	01	01	H3533_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H3533	802	0	1	01	01	H3533_802_0	2				1																																																																				
H3533	803	0	1	01	01	H3533_803_0	1	N	N		2																																																																				
H3533	805	0	1	01	01	H3533_805_0	1				1																																																																				
H3533	806	0	1	01	01	H3533_806_0	1	N	N		2																																																																				
H3536	801	0	1	01	01	H3536_801_0	4				1																																																																				
H3536	802	0	1	01	01	H3536_802_0	4	N	N		2																																																																				
H3536	803	0	2	01	01	H3536_803_0	3				1																																																																				
H3536	804	0	2	01	01	H3536_804_0	4	N	N		2																																																																				
H3536	806	0	1	01	01	H3536_806_0	4	N	N		2																																																																				
H3536	808	0	2	01	01	H3536_808_0	5	N	N		2																																																																				
H3551	001	0	1	01	01	H3551_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1, 2, and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3551	002	0	1	01	01	H3551_002_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1, 2 and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3551	003	0	1	02	01	H3551_003_0	4	N	N		2																																																																				
H3551	004	0	1	01	01	H3551_004_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0111000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1, 2, and 3. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3557	801	0	1	04	01	H3557_801_0	4				1																																																																				
H3557	802	0	1	04	01	H3557_802_0	4				1																																																																				
H3557	803	0	1	04	01	H3557_803_0	4	N	N		2																																																																				
H3561	007	0	1	01	01	H3561_007_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	555.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H3561	008	0	1	01	01	H3561_008_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	555.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H3561	009	0	1	01	01	H3561_009_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	425.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H3563	001	0	1	20	08	H3563_001_0	2				1																																																																				
H3563	002	0	1	20	08	H3563_002_0	2				1																																																																				
H3597	001	0	1	02	01	H3597_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3597	011	0	1	02	01	H3597_011_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3597	012	0	1	02	01	H3597_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3597	017	0	1	02	01	H3597_017_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3597	018	0	1	02	01	H3597_018_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3597	801	0	1	01	01	H3597_801_0	1	N	N		2																																																																				
H3597	802	0	1	01	01	H3597_802_0	1				1																																																																				
H3613	001	0	1	20	08	H3613_001_0	2				1																																																																				
H3613	002	0	1	20	08	H3613_002_0	2				1																																																																				
H3653	004	0	1	02	01	H3653_004_0	12			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	55.00	2	0110000	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0111110	1																																		1		1	1
H3653	015	0	1	02	01	H3653_015_0	15			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0111110	1																																		1		1	1
H3653	022	0	1	02	01	H3653_022_0	13			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0111110	1																																		1		1	1
H3653	803	0	1	01	01	H3653_803_0	9	N	N		2																																																																				
H3653	806	0	2	01	01	H3653_806_0	9	N	N		2																																																																				
H3653	809	0	1	01	01	H3653_809_0	9				1																																																																				
H3655	041	0	1	02	01	H3655_041_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	390.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1		1	1
H3655	045	1	1	02	01	H3655_045_1	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3655	045	2	1	02	01	H3655_045_2	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3655	045	3	1	02	01	H3655_045_3	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3655	045	4	1	02	01	H3655_045_4	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H3655	801	0	1	01	01	H3655_801_0	5				1																																																																				
H3655	803	0	1	01	01	H3655_803_0	4	N	N		2																																																																				
H3655	805	0	2	01	01	H3655_805_0	3				1																																																																				
H3655	806	0	2	01	01	H3655_806_0	4	N	N		2																																																																				
H3655	808	0	1	01	01	H3655_808_0	3	N	N		2																																																																				
H3655	810	0	2	01	01	H3655_810_0	3	N	N		2																																																																				
H3660	028	0	1	02	01	H3660_028_0	6			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The plan has lowered the deductible to $0 for all Tiers.  Reduced initial coverage phase cost sharing for Tiers 1, 2, 3, 4 and 6.	1	3		0111111	1																																		1		1	1
H3660	029	0	1	02	01	H3660_029_0	7			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	50.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $50 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 & 4 at preferred pharmacies.	1	3		0111111	1																																		1		1	1
H3660	044	0	1	01	01	H3660_044_0	7			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $150 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 & 4 at preferred pharmacies	1	3		0111111	1																																		1		1	1
H3660	050	0	1	01	01	H3660_050_0	7			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $300 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 & 4 at preferred pharmacies.	1	3		0111111	1																																		1		1	1
H3660	052	1	1	01	01	H3660_052_1	6	N	N		2																																																																				
H3660	052	2	1	01	01	H3660_052_2	6	N	N		2																																																																				
H3660	053	1	1	01	01	H3660_053_1	6			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $250 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 at preferred pharmacies.	1	3		0111111	1																																		1		1	1
H3660	053	2	1	01	01	H3660_053_2	5			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $250 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 at preferred pharmacies.	1	3		0111111	1																																		1		1	1
H3660	057	0	1	01	01	H3660_057_0	6			5F4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	The plan has waived the deductible for tiers 1, 2, and 6 and lowered the deductible to $300 for tiers 3, 4 and 5.  Reduced initial coverage phase cost sharing for Tiers 1, 2, and 6 at both standard and preferred pharmacies. Reduced initial coverage phase cost sharing for Tiers 3 & 4 at preferred pharmacies.	1	3		0111111	1																																		1		1	1
H3660	801	0	1	01	01	H3660_801_0	2				1																																																																				
H3660	802	0	1	01	01	H3660_802_0	1	N	N		2																																																																				
H3660	805	0	1	02	01	H3660_805_0	2				1																																																																				
H3660	806	0	1	02	01	H3660_806_0	1	N	N		2																																																																				
H3664	014	0	1	02	01	H3664_014_0	3	N	N		2																																																																				
H3664	017	0	1	02	01	H3664_017_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		2	3		0001100	1																																		1		1	1
H3664	020	0	1	02	01	H3664_020_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0001100	1																																		1		1	1
H3664	021	0	1	02	01	H3664_021_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	011		2	3		0001100	1																																		1		1	1
H3664	801	0	1	02	01	H3664_801_0	2				1																																																																				
H3664	802	0	1	02	01	H3664_802_0	2	N	N		2																																																																				
H3664	803	0	1	02	01	H3664_803_0	2				1																																																																				
H3664	805	0	2	02	01	H3664_805_0	2				1																																																																				
H3664	806	0	2	02	01	H3664_806_0	2	N	N		2																																																																				
H3664	807	0	1	02	01	H3664_807_0	2				1																																																																				
H3668	013	0	1	01	01	H3668_013_0	5	N	N		2																																																																				
H3668	018	1	1	01	01	H3668_018_1	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	018	2	1	01	01	H3668_018_2	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	019	1	1	01	01	H3668_019_1	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	019	2	1	01	01	H3668_019_2	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	020	0	1	01	01	H3668_020_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	022	0	1	01	01	H3668_022_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	023	0	1	01	01	H3668_023_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	025	0	1	01	01	H3668_025_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	026	0	1	01	01	H3668_026_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	029	0	1	01	01	H3668_029_0	4	N	N		2																																																																				
H3668	030	0	1	01	01	H3668_030_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	031	0	1	01	01	H3668_031_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3668	802	0	1	01	01	H3668_802_0	1				1																																																																				
H3668	803	0	1	01	01	H3668_803_0	1				1																																																																				
H3668	804	0	1	01	01	H3668_804_0	1				1																																																																				
H3668	811	0	1	01	01	H3668_811_0	1				1																																																																				
H3668	812	0	1	01	01	H3668_812_0	1				1																																																																				
H3672	013	0	1	01	01	H3672_013_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H3672	014	0	1	01	01	H3672_014_0	4	N	N		2																																																																				
H3672	019	0	1	01	01	H3672_019_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	This plan offers $0 T1 drugs that are exempt from the deductible.	2	3		0001100	1																																		1	1	1	1
H3672	020	0	1	01	01	H3672_020_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H3672	021	0	1	01	01	H3672_021_0	4	N	N		2																																																																				
H3672	023	0	1	01	01	H3672_023_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H3672	024	0	1	01	01	H3672_024_0	4	N	N		2																																																																				
H3672	805	0	1	01	01	H3672_805_0	3				1																																																																				
H3706	001	0	1	01	01	H3706_001_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0011100	1																																		1		1	1
H3706	009	0	1	01	01	H3706_009_0	3	N	N		2																																																																				
H3706	023	0	1	01	01	H3706_023_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0011100	1																																		1		1	1
H3706	024	0	1	01	01	H3706_024_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0011100	1																																		1		1	1
H3706	025	0	1	01	01	H3706_025_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0011100	1																																		1		1	1
H3706	028	0	1	01	01	H3706_028_0	5		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	1	35.00		105.00	35.00		35.00	35.00		35.00	25		25	25		25	25		25			1	1
H3706	029	0	1	01	01	H3706_029_0	5		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	1	35.00		35.00	35.00		35.00	35.00		35.00	25		25	25		25	25		25			1	1
H3706	803	0	1	01	01	H3706_803_0	1				1																																																																				
H3708	001	0	1	01	01	H3708_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3727	001	2	1	01	01	H3727_001_2	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering a $0 deductible on most/all drugs C-SNP= some. The plan also offers reduced copays on tiers 1 through 4, which on average result in lower costs to the member than the Part D standard benefit.	2	3		0011100	1																																				1	1
H3727	001	3	1	01	01	H3727_001_3	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering a $0 deductible on most/all drugs C-SNP= some. The plan also offers reduced copays on tiers 1 through 4, which on average result in lower costs to the member than the Part D standard benefit.	2	3		0011100	1																																				1	1
H3727	002	1	1	01	01	H3727_002_1	3				1	1	110110	1		2											615.00																010	30			01	30		010	30			1	31			35.00			35.00			35.00		35.00	25			25			25		25			1	1
H3727	002	2	1	01	01	H3727_002_2	2				1	1	110110	1		2											615.00																010	30			01	30		010	30			1	31			35.00			35.00			35.00		35.00	25			25			25		25			1	1
H3727	002	3	1	01	01	H3727_002_3	3				1	1	110110	1		2											615.00																010	30			01	30		010	30			1	31			35.00			35.00			35.00		35.00	25			25			25		25			1	1
H3740	001	0	1	20	08	H3740_001_0	2				1																																																																				
H3740	002	0	1	20	08	H3740_002_0	2				1																																																																				
H3748	003	0	1	01	01	H3748_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3748	801	0	1	01	01	H3748_801_0	1	N	N		2																																																																				
H3755	001	0	1	01	01	H3755_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0111110	1																																		1		1	1
H3755	002	0	1	01	01	H3755_002_0	5	N	N		2																																																																				
H3755	004	0	1	01	01	H3755_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0111110	1																																		1		1	1
H3755	005	0	1	01	01	H3755_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0111110	1																																		1		1	1
H3755	006	0	1	01	01	H3755_006_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1	1	101	Tier 1 cost sharing is enhanced to $0.	2	3		0111110	1																																		1	1	1	1
H3755	007	0	1	01	01	H3755_007_0	7	N	N		2																																																																				
H3755	801	0	1	01	01	H3755_801_0	1				1																																																																				
H3777	002	0	1	01	01	H3777_002_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	2	3		0111100	1																																		1		1	1
H3794	002	0	1	02	01	H3794_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3794	004	0	1	02	01	H3794_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3794	006	0	1	02	01	H3794_006_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3800	001	0	1	01	01	H3800_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H3805	001	0	1	02	01	H3805_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	015	0	1	02	01	H3805_015_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	017	0	1	02	01	H3805_017_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	032	0	1	02	01	H3805_032_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	033	0	1	02	01	H3805_033_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	034	0	1	02	01	H3805_034_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	035	0	1	02	01	H3805_035_0	3	N	N		2																																																																				
H3805	037	0	1	02	01	H3805_037_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	039	1	1	02	01	H3805_039_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	039	2	1	02	01	H3805_039_2	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	040	0	1	02	01	H3805_040_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	041	0	1	02	01	H3805_041_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	043	0	1	02	01	H3805_043_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	044	0	1	02	01	H3805_044_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	045	0	1	02	01	H3805_045_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H3805	801	0	1	01	01	H3805_801_0	1	N	N		2																																																																				
H3805	803	0	1	01	01	H3805_803_0	1				1																																																																				
H3805	804	0	1	01	01	H3805_804_0	1				1																																																																				
H3805	805	0	1	01	01	H3805_805_0	1	N	N		2																																																																				
H3805	806	0	1	01	01	H3805_806_0	1				1																																																																				
H3805	807	0	1	01	01	H3805_807_0	1				1																																																																				
H3809	001	0	1	20	08	H3809_001_0	2				1																																																																				
H3809	002	0	1	20	08	H3809_002_0	2				1																																																																				
H3810	023	0	1	01	01	H3810_023_0	8		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		100			100	1	31	1	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H3811	003	0	1	01	01	H3811_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	This plan offers an enhanced copays in relation to defined standard coverage.	2	3		0111100	1																																		1	1	1	1
H3814	007	0	1	01	01	H3814_007_0	10		N		1	1	110110	1		1	1										615.00																110	31		100	01	31		100			100	1	34	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H3814	030	0	1	01	01	H3814_030_0	9		N		1	1	110110	1		1	1										615.00																110	31		100	01	31		100			100	1	34	2	2	35.00		105.00			105.00	35.00		35.00	25		25			0	25		25			1	1
H3815	001	0	1	01	01	H3815_001_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	008	0	1	01	01	H3815_008_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	010	0	1	01	01	H3815_010_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	011	0	1	01	01	H3815_011_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	013	0	1	01	01	H3815_013_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	016	0	1	02	01	H3815_016_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	019	0	1	01	01	H3815_019_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	020	0	1	01	01	H3815_020_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	021	0	1	01	01	H3815_021_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	023	0	1	01	01	H3815_023_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	028	0	1	01	01	H3815_028_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	030	0	1	01	01	H3815_030_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1	1	1	1
H3815	031	0	1	01	01	H3815_031_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	033	0	1	01	01	H3815_033_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	034	0	1	01	01	H3815_034_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	035	0	1	01	01	H3815_035_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	038	0	1	01	01	H3815_038_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																				1	1
H3815	039	0	1	01	01	H3815_039_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	040	0	1	01	01	H3815_040_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																				1	1
H3815	041	0	1	01	01	H3815_041_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	042	0	1	01	01	H3815_042_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	044	0	1	01	01	H3815_044_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	045	0	1	01	01	H3815_045_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	046	0	1	01	01	H3815_046_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	047	0	1	01	01	H3815_047_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	048	0	1	01	01	H3815_048_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	049	0	1	01	01	H3815_049_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	050	0	1	01	01	H3815_050_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	051	0	1	01	01	H3815_051_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	052	0	1	01	01	H3815_052_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H3815	053	0	1	01	01	H3815_053_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H3815	054	0	1	01	01	H3815_054_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	055	0	1	01	01	H3815_055_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H3815	056	0	1	01	01	H3815_056_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H3815	801	0	1	01	01	H3815_801_0	1				1																																																																				
H3815	802	0	1	01	01	H3815_802_0	1				1																																																																				
H3815	803	0	1	01	01	H3815_803_0	1	N	N		2																																																																				
H3815	804	0	1	01	01	H3815_804_0	1	N	N		2																																																																				
H3817	008	1	1	04	01	H3817_008_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	008	2	1	04	01	H3817_008_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	008	4	1	04	01	H3817_008_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	009	1	1	04	01	H3817_009_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	009	2	1	04	01	H3817_009_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	010	0	1	04	01	H3817_010_0	5	N	N		2																																																																				
H3817	011	1	1	04	01	H3817_011_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	011	2	1	04	01	H3817_011_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	011	3	1	04	01	H3817_011_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H3817	801	0	1	04	01	H3817_801_0	3	N	N		2																																																																				
H3817	802	0	1	04	01	H3817_802_0	3				1																																																																				
H3817	803	0	1	04	01	H3817_803_0	3				1																																																																				
H3817	804	0	1	04	01	H3817_804_0	3				1																																																																				
H3822	001	0	1	01	01	H3822_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	002	0	1	01	01	H3822_002_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	007	0	1	02	01	H3822_007_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	008	0	1	02	01	H3822_008_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	012	0	1	01	01	H3822_012_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	014	0	1	01	01	H3822_014_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3822	801	0	1	01	01	H3822_801_0	2				1																																																																				
H3822	802	0	1	01	01	H3822_802_0	2				1																																																																				
H3822	805	0	1	01	01	H3822_805_0	2				1																																																																				
H3822	806	0	1	01	01	H3822_806_0	2				1																																																																				
H3822	809	0	1	01	01	H3822_809_0	2	N	N		2																																																																				
H3822	810	0	1	01	01	H3822_810_0	2	N	N		2																																																																				
H3822	813	0	1	01	01	H3822_813_0	2				1																																																																				
H3822	814	0	1	01	01	H3822_814_0	2				1																																																																				
H3822	815	0	1	01	01	H3822_815_0	2	N	N		2																																																																				
H3822	816	0	1	01	01	H3822_816_0	2				1																																																																				
H3822	817	0	1	01	01	H3822_817_0	2				1																																																																				
H3822	818	0	1	01	01	H3822_818_0	2				1																																																																				
H3828	001	0	1	04	01	H3828_001_0	6			5F	1	4	101110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H3828	801	0	1	04	01	H3828_801_0	1				1																																																																				
H3828	802	0	1	04	01	H3828_802_0	1				1																																																																				
H3832	007	0	1	04	01	H3832_007_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				2	1	111	We are offering copayments for Tier 1 and Tier 2, and coinsurance for Tier 3 with cost-sharing amounts that are lower than the Defined Standard for this phase.  Additionally, we are reducing the deductible below the Defined Standard for this plan and waiving the deductible for Tier 1.	2	3		0111110	1																																		1		1	1
H3832	008	0	1	04	01	H3832_008_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0100000	1				2	1	111	We are offering copayments for Tier 1 and Tier 2, and coinsurance for Tier 3 with cost-sharing amounts that are lower than the Defined Standard for this phase.  Additionally, we are reducing the deductible below the Defined Standard for this plan and waiving the deductible for Tier 1.	2	3		0111110	1																																		1		1	1
H3832	009	0	1	04	01	H3832_009_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				2	1	111	We are offering copayments for Tier 1 and Tier 2, and coinsurance for Tier 3 with cost-sharing amounts that are lower than the Defined Standard for this phase.  Additionally, we are reducing the deductible below the Defined Standard for this plan and waiving the deductible for Tier 1.	2	3		0111110	1																																		1		1	1
H3832	010	0	1	04	01	H3832_010_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0100000	1				2	1	111	We are offering copayments for Tier 1 and Tier 2, and coinsurance for Tier 3 with cost-sharing amounts that are lower than the Defined Standard for this phase.  Additionally, we are reducing the deductible below the Defined Standard for this plan and waiving the deductible for Tier 1.	2	3		0111110	1																																		1		1	1
H3832	801	0	1	04	01	H3832_801_0	3				1																																																																				
H3832	802	0	1	04	01	H3832_802_0	3				1																																																																				
H3832	805	0	1	04	01	H3832_805_0	3	N	N		2																																																																				
H3832	807	0	1	04	01	H3832_807_0	3				1																																																																				
H3864	002	0	1	02	01	H3864_002_0	4	N	N		2																																																																				
H3864	006	0	1	01	01	H3864_006_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	99.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	014	0	1	02	01	H3864_014_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	199.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	024	0	1	02	01	H3864_024_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	499.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	027	0	1	01	01	H3864_027_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	399.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	029	0	1	02	01	H3864_029_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	299.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	030	0	1	02	01	H3864_030_0	5	N	N		2																																																																				
H3864	034	0	1	02	01	H3864_034_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	199.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	036	0	1	02	01	H3864_036_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	499.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	040	0	1	01	01	H3864_040_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	399.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	041	0	1	01	01	H3864_041_0	5			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	499.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H3864	043	0	1	01	01	H3864_043_0	7		N	5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The Part D benefit is enhanced beyond the defined standard benefit through lower copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1	1	1	1
H3864	045	0	1	01	01	H3864_045_0	7		N	5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The Part D benefit is enhanced beyond the defined standard benefit through lower copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1	1	1	1
H3864	801	0	1	01	01	H3864_801_0	4	N	N		2																																																																				
H3864	803	0	1	01	01	H3864_803_0	4				1																																																																				
H3864	805	0	1	02	01	H3864_805_0	4	N	N		2																																																																				
H3864	806	0	1	02	01	H3864_806_0	4				1																																																																				
H3868	001	0	1	02	01	H3868_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H3890	001	0	1	04	01	H3890_001_0	9			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan offers $0 copay on Tier 1 and a $15 copay on Tier 2, with a cost-share structure of the lesser of coinsurance and copayment. The average expected cost will be no more than 25% of the actual cost on Tier 2.	1	3		0111110	1																																		1		1	1
H3890	002	0	1	04	01	H3890_002_0	9			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan offers $0 copay on Tier 1 and a $15 copay on Tier 2, with a cost-share structure of the lesser of coinsurance and copayment. The average expected cost will be no more than 25% of the actual cost on Tier 2.	1	3		0111110	1																																		1		1	1
H3890	005	0	1	04	01	H3890_005_0	10			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				1	1	111	This plan offers $0 copay on Tier 1 and a $6 copay on Tier 2, with a cost-share structure of the lesser of coinsurance and copayment. The average expected cost will be no more than 25% of the actual cost on Tier 2.	1	3		0111110	1																																		1		1	1
H3890	801	0	1	04	01	H3890_801_0	2				1																																																																				
H3907	002	0	1	01	01	H3907_002_0	13	N	N		2																																																																				
H3907	006	0	1	01	01	H3907_006_0	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	037	0	1	01	01	H3907_037_0	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	1	1	01	01	H3907_057_1	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	2	1	01	01	H3907_057_2	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	3	1	01	01	H3907_057_3	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	4	1	01	01	H3907_057_4	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	5	1	01	01	H3907_057_5	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	6	1	01	01	H3907_057_6	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	057	7	1	01	01	H3907_057_7	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	058	1	1	01	01	H3907_058_1	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	058	2	1	01	01	H3907_058_2	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	058	3	1	01	01	H3907_058_3	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	059	1	1	01	01	H3907_059_1	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	059	2	1	01	01	H3907_059_2	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	059	3	1	01	01	H3907_059_3	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	059	4	1	01	01	H3907_059_4	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	059	5	1	01	01	H3907_059_5	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H3907	801	0	1	01	01	H3907_801_0	4	N	N		2																																																																				
H3907	802	0	1	01	01	H3907_802_0	4				1																																																																				
H3907	803	0	1	01	01	H3907_803_0	4				1																																																																				
H3907	804	0	1	01	01	H3907_804_0	4				1																																																																				
H3908	001	0	1	20	08	H3908_001_0	2				1																																																																				
H3908	002	0	1	20	08	H3908_002_0	2				1																																																																				
H3909	001	0	1	04	01	H3909_001_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3909	007	0	1	04	01	H3909_007_0	6	N	N		2																																																																				
H3909	009	0	1	04	01	H3909_009_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3909	018	0	1	04	01	H3909_018_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3909	020	0	1	04	01	H3909_020_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				1	1	111	The plan features a reduced deductible, with Tier 1 and Tier 2 drugs excluded from the deductible and covered with a $0 copay at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3909	801	0	1	04	01	H3909_801_0	3	N	N		2																																																																				
H3909	802	0	1	04	01	H3909_802_0	3				1																																																																				
H3916	001	0	1	04	01	H3916_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	002	0	1	04	01	H3916_002_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	005	0	1	04	01	H3916_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	012	0	1	04	01	H3916_012_0	5	N	N		2																																																																				
H3916	015	0	1	04	01	H3916_015_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	018	0	1	04	01	H3916_018_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3916	022	0	1	04	01	H3916_022_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	024	0	1	04	01	H3916_024_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3916	032	0	1	04	01	H3916_032_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3916	033	0	1	04	01	H3916_033_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3916	035	1	1	04	01	H3916_035_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	035	2	1	04	01	H3916_035_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	2	1	04	01	H3916_037_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	4	1	04	01	H3916_037_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	5	1	04	01	H3916_037_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	6	1	04	01	H3916_037_6	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	7	1	04	01	H3916_037_7	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	037	8	1	04	01	H3916_037_8	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	038	0	1	04	01	H3916_038_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	039	0	1	04	01	H3916_039_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	041	1	1	04	01	H3916_041_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	041	2	1	04	01	H3916_041_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	041	3	1	04	01	H3916_041_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	043	0	1	04	01	H3916_043_0	5	N	N		2																																																																				
H3916	056	0	1	04	01	H3916_056_0	5	N	N		2																																																																				
H3916	057	0	1	04	01	H3916_057_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	058	0	1	04	01	H3916_058_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	059	1	1	04	01	H3916_059_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	059	2	1	04	01	H3916_059_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	1	1	04	01	H3916_060_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	2	1	04	01	H3916_060_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	3	1	04	01	H3916_060_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	4	1	04	01	H3916_060_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	5	1	04	01	H3916_060_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	060	6	1	04	01	H3916_060_6	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	061	1	1	04	01	H3916_061_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	061	2	1	04	01	H3916_061_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	062	0	1	04	01	H3916_062_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	063	0	1	04	01	H3916_063_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	064	0	1	04	01	H3916_064_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	065	0	1	04	01	H3916_065_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	066	0	1	04	01	H3916_066_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3916	067	0	1	04	01	H3916_067_0	5	N	N		2																																																																				
H3916	801	0	1	04	01	H3916_801_0	2	N	N		2																																																																				
H3916	802	0	1	04	01	H3916_802_0	2				1																																																																				
H3916	804	0	1	04	01	H3916_804_0	2				1																																																																				
H3916	805	0	1	04	01	H3916_805_0	2	N	N		2																																																																				
H3916	806	0	1	04	01	H3916_806_0	2				1																																																																				
H3916	807	0	1	04	01	H3916_807_0	2				1																																																																				
H3916	808	0	1	04	01	H3916_808_0	2				1																																																																				
H3916	809	0	1	04	01	H3916_809_0	2				1																																																																				
H3916	810	0	1	04	01	H3916_810_0	2				1																																																																				
H3917	001	0	1	20	08	H3917_001_0	2				1																																																																				
H3917	002	0	1	20	08	H3917_002_0	2				1																																																																				
H3918	001	0	1	20	08	H3918_001_0	2				1																																																																				
H3918	002	0	1	20	08	H3918_002_0	2				1																																																																				
H3919	001	0	1	20	08	H3919_001_0	2				1																																																																				
H3919	002	0	1	20	08	H3919_002_0	2				1																																																																				
H3923	013	0	1	04	01	H3923_013_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	017	0	1	04	01	H3923_017_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																				1	1
H3923	044	1	1	04	01	H3923_044_1	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	044	2	1	04	01	H3923_044_2	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	044	3	1	04	01	H3923_044_3	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	044	4	1	04	01	H3923_044_4	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	045	1	1	04	01	H3923_045_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	045	2	1	04	01	H3923_045_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	045	3	1	04	01	H3923_045_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	045	4	1	04	01	H3923_045_4	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	045	5	1	04	01	H3923_045_5	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	046	1	1	04	01	H3923_046_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	046	2	1	04	01	H3923_046_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	046	3	1	04	01	H3923_046_3	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	046	4	1	04	01	H3923_046_4	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	047	1	1	04	01	H3923_047_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	047	2	1	04	01	H3923_047_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	047	3	1	04	01	H3923_047_3	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	047	4	1	04	01	H3923_047_4	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	047	5	1	04	01	H3923_047_5	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	048	2	1	04	01	H3923_048_2	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	048	3	1	04	01	H3923_048_3	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	048	5	1	04	01	H3923_048_5	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3923	801	0	1	04	01	H3923_801_0	1				1																																																																				
H3923	802	0	1	04	01	H3923_802_0	1	N	N		2																																																																				
H3923	817	0	1	04	01	H3923_817_0	1				1																																																																				
H3923	818	0	1	04	01	H3923_818_0	1				1																																																																				
H3923	819	0	1	04	01	H3923_819_0	1				1																																																																				
H3923	820	0	1	04	01	H3923_820_0	1				1																																																																				
H3923	832	0	1	04	01	H3923_832_0	1	N	N		2																																																																				
H3924	059	21	1	04	01	H3924_059_21	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3924	059	22	1	04	01	H3924_059_22	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3924	065	0	1	04	01	H3924_065_0	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3924	804	0	1	04	01	H3924_804_0	2				1																																																																				
H3924	805	0	1	04	01	H3924_805_0	2	N	N		2																																																																				
H3925	001	0	1	20	08	H3925_001_0	2				1																																																																				
H3925	002	0	1	20	08	H3925_002_0	2				1																																																																				
H3928	001	0	1	01	01	H3928_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3928	801	0	1	01	01	H3928_801_0	1				1																																																																				
H3928	803	0	1	01	01	H3928_803_0	1	N	N		2																																																																				
H3931	004	0	1	02	01	H3931_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	091	0	1	02	01	H3931_091_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	092	0	1	01	01	H3931_092_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	094	0	1	01	01	H3931_094_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	095	0	1	02	01	H3931_095_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	099	0	1	02	01	H3931_099_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	100	0	1	02	01	H3931_100_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	101	0	1	02	01	H3931_101_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	102	0	1	01	01	H3931_102_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	107	0	1	02	01	H3931_107_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	108	0	1	01	01	H3931_108_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	109	0	1	02	01	H3931_109_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	126	0	1	01	01	H3931_126_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	129	0	1	01	01	H3931_129_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	143	0	1	02	01	H3931_143_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	146	0	1	01	01	H3931_146_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	151	0	1	01	01	H3931_151_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	152	0	1	01	01	H3931_152_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	153	0	1	02	01	H3931_153_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	154	0	1	02	01	H3931_154_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	157	0	1	01	01	H3931_157_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	158	0	1	02	01	H3931_158_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	160	0	1	01	01	H3931_160_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	162	0	1	01	01	H3931_162_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	175	0	1	01	01	H3931_175_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3931	188	0	1	01	01	H3931_188_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	190	0	1	02	01	H3931_190_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	191	0	1	01	01	H3931_191_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	196	0	1	01	01	H3931_196_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3931	197	0	1	01	01	H3931_197_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3931	801	0	1	01	01	H3931_801_0	1	N	N		2																																																																				
H3931	804	0	1	01	01	H3931_804_0	1				1																																																																				
H3933	001	0	1	20	08	H3933_001_0	2				1																																																																				
H3933	002	0	1	20	08	H3933_002_0	2				1																																																																				
H3942	001	0	1	20	08	H3942_001_0	2				1																																																																				
H3942	002	0	1	20	08	H3942_002_0	2				1																																																																				
H3949	009	0	1	01	01	H3949_009_0	9		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H3949	024	0	1	01	01	H3949_024_0	5			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	275.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H3949	030	0	1	01	01	H3949_030_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	031	0	1	01	01	H3949_031_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	035	0	1	01	01	H3949_035_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	045	0	1	01	01	H3949_045_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	047	0	1	01	01	H3949_047_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	048	0	1	01	01	H3949_048_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	049	0	1	01	01	H3949_049_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	052	0	1	01	01	H3949_052_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	053	0	1	01	01	H3949_053_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	054	0	1	01	01	H3949_054_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H3949	804	0	1	01	01	H3949_804_0	1				1																																																																				
H3952	008	0	1	01	01	H3952_008_0	6	N	N		2																																																																				
H3952	020	0	1	01	01	H3952_020_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	045	0	1	01	01	H3952_045_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	048	0	1	01	01	H3952_048_0	5	N	N		2																																																																				
H3952	049	0	1	01	01	H3952_049_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	050	0	1	01	01	H3952_050_0	6	N	N		2																																																																				
H3952	051	0	1	01	01	H3952_051_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	053	0	1	02	01	H3952_053_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	054	0	1	02	01	H3952_054_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	055	0	1	01	01	H3952_055_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	059	0	1	01	01	H3952_059_0	6	N	N		2																																																																				
H3952	060	0	1	02	01	H3952_060_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H3952	802	0	1	01	01	H3952_802_0	3	N	N		2																																																																				
H3952	804	0	1	01	01	H3952_804_0	3				1																																																																				
H3954	097	0	1	01	01	H3954_097_0	3		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Requirement for increase of the actuarial value of benefits is increased by waiving deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1	1	1	1
H3954	157	21	1	01	01	H3954_157_21	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	157	22	1	01	01	H3954_157_22	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	157	23	1	01	01	H3954_157_23	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	158	13	1	01	01	H3954_158_13	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	158	14	1	01	01	H3954_158_14	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	160	0	1	01	01	H3954_160_0	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	161	0	1	01	01	H3954_161_0	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	162	0	1	01	01	H3954_162_0	3	N	N		2																																																																				
H3954	163	0	1	01	01	H3954_163_0	3			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Requirement for increase of the actuarial value of benefits is increased by the reduction of deductible and reduction in the initial coverage phase cost shares.	2	3		0001100	1																																		1		1	1
H3954	801	0	1	01	01	H3954_801_0	1	N	N		2																																																																				
H3954	802	0	1	01	01	H3954_802_0	1				1																																																																				
H3954	805	0	1	01	01	H3954_805_0	1				1																																																																				
H3954	806	0	1	01	01	H3954_806_0	1				1																																																																				
H3957	031	0	1	02	01	H3957_031_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3957	042	1	1	01	01	H3957_042_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	042	2	1	01	01	H3957_042_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	042	4	1	01	01	H3957_042_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	042	5	1	01	01	H3957_042_5	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	042	6	1	01	01	H3957_042_6	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	042	7	1	01	01	H3957_042_7	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	043	1	1	02	01	H3957_043_1	5	N	N		2																																																																				
H3957	043	2	1	02	01	H3957_043_2	4	N	N		2																																																																				
H3957	044	1	1	02	01	H3957_044_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3957	044	4	1	02	01	H3957_044_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																		1		1	1
H3957	045	1	1	02	01	H3957_045_1	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3957	045	2	1	02	01	H3957_045_2	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3957	046	1	1	02	01	H3957_046_1	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3957	046	2	1	02	01	H3957_046_2	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H3957	047	1	1	01	01	H3957_047_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	047	2	1	01	01	H3957_047_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	047	3	1	01	01	H3957_047_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	047	4	1	01	01	H3957_047_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	047	5	1	01	01	H3957_047_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	048	0	1	01	01	H3957_048_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	1	1	01	01	H3957_049_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	2	1	01	01	H3957_049_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	3	1	01	01	H3957_049_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	4	1	01	01	H3957_049_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	5	1	01	01	H3957_049_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	6	1	01	01	H3957_049_6	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	049	7	1	01	01	H3957_049_7	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	050	1	1	01	01	H3957_050_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	050	2	1	01	01	H3957_050_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	050	3	1	01	01	H3957_050_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	050	4	1	01	01	H3957_050_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	050	5	1	01	01	H3957_050_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H3957	805	0	1	01	01	H3957_805_0	2	N	N		2																																																																				
H3957	806	0	1	01	01	H3957_806_0	2				1																																																																				
H3957	808	0	1	01	01	H3957_808_0	2				1																																																																				
H3957	810	0	1	01	01	H3957_810_0	1	N	N		2																																																																				
H3957	811	0	1	01	01	H3957_811_0	2				1																																																																				
H3957	812	0	1	01	01	H3957_812_0	2				1																																																																				
H3957	813	0	1	02	01	H3957_813_0	2	N	N		2																																																																				
H3957	814	0	1	02	01	H3957_814_0	2				1																																																																				
H3957	815	0	1	02	01	H3957_815_0	2				1																																																																				
H3957	816	0	1	01	01	H3957_816_0	2				1																																																																				
H3957	817	0	1	02	01	H3957_817_0	2				1																																																																				
H3957	818	0	1	01	01	H3957_818_0	2				1																																																																				
H3959	001	0	1	02	01	H3959_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	002	0	1	02	01	H3959_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	010	0	1	02	01	H3959_010_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	011	0	1	02	01	H3959_011_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	032	0	1	02	01	H3959_032_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	033	0	1	02	01	H3959_033_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	035	0	1	01	01	H3959_035_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	036	0	1	01	01	H3959_036_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	037	0	1	02	01	H3959_037_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	039	0	1	02	01	H3959_039_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	041	0	1	02	01	H3959_041_0	3	N	N		2																																																																				
H3959	052	0	1	02	01	H3959_052_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	053	0	1	02	01	H3959_053_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	055	0	1	01	01	H3959_055_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	056	0	1	01	01	H3959_056_0	2	N	N		2																																																																				
H3959	066	0	1	01	01	H3959_066_0	4				1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H3959	069	0	1	01	01	H3959_069_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	070	0	1	01	01	H3959_070_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	071	0	1	01	01	H3959_071_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	072	0	1	01	01	H3959_072_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	073	0	1	01	01	H3959_073_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H3959	074	0	1	01	01	H3959_074_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	075	0	1	01	01	H3959_075_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	076	0	1	01	01	H3959_076_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	083	0	1	01	01	H3959_083_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	084	0	1	01	01	H3959_084_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	085	0	1	01	01	H3959_085_0	2			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H3959	804	0	1	01	01	H3959_804_0	1				1																																																																				
H3962	001	0	1	01	01	H3962_001_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																				1	1
H3962	004	0	1	01	01	H3962_004_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	022	1	1	01	01	H3962_022_1	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	022	2	1	01	01	H3962_022_2	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	022	3	1	01	01	H3962_022_3	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	022	4	1	01	01	H3962_022_4	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	022	5	1	01	01	H3962_022_5	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	011		2	3		0111110	1																																		1		1	1
H3962	801	0	1	01	01	H3962_801_0	1				1																																																																				
H3962	802	0	1	01	01	H3962_802_0	1	N	N		2																																																																				
H3962	813	0	1	01	01	H3962_813_0	1				1																																																																				
H3962	817	0	1	01	01	H3962_817_0	1				1																																																																				
H3962	828	0	1	01	01	H3962_828_0	1	N	N		2																																																																				
H3975	001	0	1	04	01	H3975_001_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H3975	002	0	1	04	01	H3975_002_0	7	N	N		2																																																																				
H3975	004	0	1	04	01	H3975_004_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H3979	001	0	1	01	01	H3979_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H3979	801	0	1	01	01	H3979_801_0	2				1																																																																				
H3979	803	0	1	01	01	H3979_803_0	2				1																																																																				
H3979	805	0	1	01	01	H3979_805_0	2	N	N		2																																																																				
H3991	001	0	1	20	08	H3991_001_0	2				1																																																																				
H3991	002	0	1	20	08	H3991_002_0	2				1																																																																				
H4003	009	0	1	01	01	H4003_009_0	5			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4003	017	0	1	01	01	H4003_017_0	6		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4003	019	0	1	02	01	H4003_019_0	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis. Excluded drug coverage is also provided for some of the drugs included in the FRF Exclusion list.	1	3		1000111	1																																				1	1
H4003	034	0	1	02	01	H4003_034_0	5			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis. Excluded drug coverage is also provided for some of the drugs included in the FRF Exclusion list.	1	3		1000111	1																																				1	1
H4003	055	0	1	02	01	H4003_055_0	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4003	058	0	1	01	01	H4003_058_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4003	806	0	1	02	01	H4003_806_0	2				1																																																																				
H4003	807	0	1	02	01	H4003_807_0	2				1																																																																				
H4003	820	0	1	02	01	H4003_820_0	2				1																																																																				
H4003	821	0	1	02	01	H4003_821_0	2				1																																																																				
H4003	822	0	1	02	01	H4003_822_0	2				1																																																																				
H4003	823	0	1	02	01	H4003_823_0	2				1																																																																				
H4003	824	0	1	02	01	H4003_824_0	2				1																																																																				
H4003	825	0	1	02	01	H4003_825_0	2				1																																																																				
H4003	826	0	1	02	01	H4003_826_0	2				1																																																																				
H4003	827	0	1	02	01	H4003_827_0	2				1																																																																				
H4003	828	0	1	02	01	H4003_828_0	2				1																																																																				
H4003	829	0	1	02	01	H4003_829_0	2				1																																																																				
H4003	830	0	1	02	01	H4003_830_0	2				1																																																																				
H4003	831	0	1	02	01	H4003_831_0	2				1																																																																				
H4004	048	0	1	01	01	H4004_048_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	056	0	1	02	01	H4004_056_0	7			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis. Excluded drug coverage is also provided for some of the drugs included in the FRF Exclusion list.	1	3		1000111	1																																				1	1
H4004	065	0	1	02	01	H4004_065_0	5			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis. Excluded drug coverage is also provided for some of the drugs included in the FRF Exclusion list.	1	3		1000111	1																																				1	1
H4004	066	0	1	02	01	H4004_066_0	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4004	068	0	1	01	01	H4004_068_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	069	0	1	01	01	H4004_069_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	070	0	1	02	01	H4004_070_0	5			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis. Excluded drug coverage is also provided for some of the drugs included in the FRF Exclusion list.	2	3		1000111	1																																				1	1
H4004	071	0	1	02	01	H4004_071_0	5			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4004	072	1	1	01	01	H4004_072_1	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	072	2	1	01	01	H4004_072_2	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	072	3	1	01	01	H4004_072_3	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H4004	073	1	1	02	01	H4004_073_1	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4004	073	2	1	02	01	H4004_073_2	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4004	073	3	1	02	01	H4004_073_3	6			6E4	1	4	110110	1	2	2		7	6	1	4			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		3								2	1	110	The actuarial value of the benefits is increased by eliminating the member cost-sharing during the deductible phase, placing drugs in a lower cost sharing tier, and reducing the member cost-sharing in the initial coverage phase on a tier-by-tier basis.	2	3		1000111	1																																				1	1
H4004	817	0	1	02	01	H4004_817_0	2				1																																																																				
H4004	818	0	1	02	01	H4004_818_0	2				1																																																																				
H4004	819	0	1	02	01	H4004_819_0	2				1																																																																				
H4004	820	0	1	02	01	H4004_820_0	2				1																																																																				
H4004	822	0	1	02	01	H4004_822_0	2				1																																																																				
H4004	823	0	1	02	01	H4004_823_0	2				1																																																																				
H4004	824	0	1	02	01	H4004_824_0	2				1																																																																				
H4004	825	0	1	02	01	H4004_825_0	2				1																																																																				
H4004	826	0	1	02	01	H4004_826_0	2				1																																																																				
H4004	827	0	1	02	01	H4004_827_0	2				1																																																																				
H4004	828	0	1	02	01	H4004_828_0	2				1																																																																				
H4004	829	0	1	02	01	H4004_829_0	2				1																																																																				
H4004	830	0	1	02	01	H4004_830_0	2				1																																																																				
H4004	831	0	1	02	01	H4004_831_0	2				1																																																																				
H4005	004	0	1	04	01	H4005_004_0	5			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H4005	801	0	1	04	01	H4005_801_0	2	N	N		2																																																																				
H4005	802	0	1	04	01	H4005_802_0	2				1																																																																				
H4005	804	0	1	04	01	H4005_804_0	2				1																																																																				
H4005	807	0	1	04	01	H4005_807_0	2				1																																																																				
H4005	808	0	1	04	01	H4005_808_0	2				1																																																																				
H4005	809	0	1	04	01	H4005_809_0	2				1																																																																				
H4005	810	0	1	04	01	H4005_810_0	2				1																																																																				
H4026	001	0	1	01	01	H4026_001_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H4026	002	0	1	01	01	H4026_002_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H4032	001	0	1	02	01	H4032_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H4032	002	0	1	02	01	H4032_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H4036	008	0	1	04	01	H4036_008_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	017	0	1	04	01	H4036_017_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	022	0	1	04	01	H4036_022_0	4	N	N		2																																																																				
H4036	024	0	1	04	01	H4036_024_0	5	N	N		2																																																																				
H4036	025	0	1	04	01	H4036_025_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	026	0	1	04	01	H4036_026_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	030	0	1	04	01	H4036_030_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	034	0	1	04	01	H4036_034_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	036	0	1	04	01	H4036_036_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4036	040	0	1	04	01	H4036_040_0	4	N	N		2																																																																				
H4036	801	0	1	04	01	H4036_801_0	3				1																																																																				
H4036	802	0	1	04	01	H4036_802_0	3	N	N		2																																																																				
H4036	805	0	1	04	01	H4036_805_0	3				1																																																																				
H4036	806	0	2	04	01	H4036_806_0	3				1																																																																				
H4036	807	0	1	04	01	H4036_807_0	3	N	N		2																																																																				
H4036	809	0	2	04	01	H4036_809_0	3	N	N		2																																																																				
H4036	810	0	2	04	01	H4036_810_0	3	N	N		2																																																																				
H4036	812	0	1	04	01	H4036_812_0	3	N	N		2																																																																				
H4036	813	0	1	04	01	H4036_813_0	3	N	N		2																																																																				
H4036	814	0	1	04	01	H4036_814_0	3	N	N		2																																																																				
H4036	819	0	1	04	01	H4036_819_0	3				1																																																																				
H4036	820	0	1	04	01	H4036_820_0	3	N	N		2																																																																				
H4036	821	0	2	04	01	H4036_821_0	3				1																																																																				
H4036	822	0	2	04	01	H4036_822_0	3	N	N		2																																																																				
H4036	823	0	1	04	01	H4036_823_0	3				1																																																																				
H4036	824	0	1	04	01	H4036_824_0	3	N	N		2																																																																				
H4036	825	0	2	04	01	H4036_825_0	3				1																																																																				
H4036	826	0	2	04	01	H4036_826_0	3	N	N		2																																																																				
H4036	827	0	1	04	01	H4036_827_0	3				1																																																																				
H4036	828	0	1	04	01	H4036_828_0	3	N	N		2																																																																				
H4036	829	0	2	04	01	H4036_829_0	3				1																																																																				
H4036	830	0	2	04	01	H4036_830_0	3	N	N		2																																																																				
H4045	001	0	1	01	01	H4045_001_0	3		N	5I4	1	4	110110	1	2	2		6	3	2				Generic, Preferred Brand, Non-Preferred Brand, Preferred Specialty Tier, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	2	1	0		3	1	101	Cost shares reduced below defined standard levels.	2	3		0111000	1																																		1	1	1	1
H4053	001	0	1	20	08	H4053_001_0	2				1																																																																				
H4053	002	0	1	20	08	H4053_002_0	2				1																																																																				
H4054	001	0	1	01	01	H4054_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4057	001	0	1	01	01	H4057_001_0	4		N	5F4	1	4	110110	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	001		1	3		0111111	1																																		1	1	1	1
H4073	001	0	1	02	01	H4073_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4073	002	0	1	02	01	H4073_002_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	385.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4073	003	0	1	02	01	H4073_003_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H4073	004	0	1	02	01	H4073_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	425.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4074	001	0	1	20	08	H4074_001_0	2				1																																																																				
H4074	002	0	1	20	08	H4074_002_0	2				1																																																																				
H4091	001	0	1	04	01	H4091_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H4091	002	0	1	04	01	H4091_002_0	4		N		1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H4091	003	0	1	04	01	H4091_003_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	1						3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible.  This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H4093	001	0	1	01	01	H4093_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4093	004	0	1	01	01	H4093_004_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4093	008	0	1	01	01	H4093_008_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4105	001	0	1	20	08	H4105_001_0	2				1																																																																				
H4105	002	0	1	20	08	H4105_002_0	2				1																																																																				
H4118	001	0	1	20	08	H4118_001_0	3				1																																																																				
H4118	002	0	1	20	08	H4118_002_0	2				1																																																																				
H4140	001	0	1	01	01	H4140_001_0	8			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1, 2, and 3 and a $55 copay for drugs on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4140	002	0	1	01	01	H4140_002_0	8		N	5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				1	1	101	This plan waives the Part D Deductible on Tiers 1, 2 and 6. This plan offers reduced $0 copays for drugs on Tiers 1, 2 and 6 and offers coverage for supplemental excluded drugs.	1	3		0011110	1																																		1	1	1	1
H4140	004	0	1	01	01	H4140_004_0	8			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1, 2, and 3, and a $55 copay on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4140	012	0	1	01	01	H4140_012_0	8			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1, 2, and 3 and a $55 copay for drugs on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4140	013	0	1	01	01	H4140_013_0	8		N	5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				1	1	101	This plan waives the Part D Deductible on Tiers 1, 2 and 6. This plan offers reduced $0 copays for drugs on Tiers 1, 2 and 6 and offers coverage for supplemental excluded drugs.	1	3		0011110	1																																		1	1	1	1
H4140	016	0	1	01	01	H4140_016_0	8			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1, 2, and 3 and a $55 copay for drugs on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4140	017	0	1	01	01	H4140_017_0	8		N	5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				1	1	101	This plan waives the Part D Deductible on Tiers 1, 2 and 6. This plan offers reduced $0 copays for drugs on Tiers 1, 2 and 6 and offers coverage for supplemental excluded drugs.	1	3		0011110	1																																		1	1	1	1
H4140	018	0	1	01	01	H4140_018_0	8			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1 and 2, a $20 copay on Tier 3 and a $60 copay on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4140	019	0	1	01	01	H4140_019_0	6			5F1	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								1	1	110	This plan offers a $0 Part D Deductible as well as reduced $0 copays for drugs on Tiers 1 and 2, a $47 copay for drugs on Tier 3, and a $100 copay on Tier 4. Additionally, this plan offers coverage for supplemental excluded drugs.	1	3		0011110	1																																				1	1
H4141	003	0	1	01	01	H4141_003_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4141	015	0	1	01	01	H4141_015_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4141	017	3	1	01	01	H4141_017_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4141	017	5	1	01	01	H4141_017_5	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4141	022	0	1	01	01	H4141_022_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4141	023	0	1	01	01	H4141_023_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4141	024	0	1	01	01	H4141_024_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4141	025	0	1	01	01	H4141_025_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4141	801	0	1	01	01	H4141_801_0	1				1																																																																				
H4141	802	0	1	01	01	H4141_802_0	1	N	N		2																																																																				
H4141	805	0	1	01	01	H4141_805_0	1				1																																																																				
H4141	806	0	1	01	01	H4141_806_0	1	N	N		2																																																																				
H4142	001	0	1	20	08	H4142_001_0	2				1																																																																				
H4142	002	0	1	20	08	H4142_002_0	2				1																																																																				
H4152	004	0	1	01	01	H4152_004_0	6	N	N		2																																																																				
H4152	013	0	1	02	01	H4152_013_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				1	1	111	On average, because of the reduced deductible and reduced initial coverage phase cost shares, projected out-of-pocket expense per member is lower for this plan than it is for the standard Part D benefit.	2	3		0111100	1																																		1		1	1
H4152	018	0	1	02	01	H4152_018_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	111	On average, because of the reduced deductible and reduced initial coverage phase cost shares, projected out-of-pocket expense per member is lower for this plan than it is for the standard Part D benefit.	2	3		0111100	1																																		1		1	1
H4152	021	0	1	01	01	H4152_021_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						1	1	100	On average, because of the reduced initial coverage phase cost shares, projected out-of-pocket expense per member is lower for this plan than it is for the standard Part D benefit.	2	3		0111100	1																																		1	1	1	1
H4152	022	0	1	02	01	H4152_022_0	6				1	1	110110	1		2											615.00																111	30	60	100	01	30		101		60	100	1	31	2	2	35.00	70.00	105.00		70.00	105.00	35.00		35.00	25	25	25		25	25	25		25			1	1
H4152	023	0	1	02	01	H4152_023_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	On average, because of the deductible not on all tiers and reduced initial coverage phase cost shares, projected out-of-pocket expense per member is lower for this plan than it is for the standard Part D benefit.	2	3		0111100	1																																		1		1	1
H4152	815	0	1	02	01	H4152_815_0	4				1																																																																				
H4152	817	0	1	01	01	H4152_817_0	4				1																																																																				
H4158	001	0	1	01	01	H4158_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	410.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4161	002	0	1	02	01	H4161_002_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H4161	003	0	1	02	01	H4161_003_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4161	004	0	1	02	01	H4161_004_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4161	005	0	1	02	01	H4161_005_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	110.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4161	006	0	1	02	01	H4161_006_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4161	007	0	1	02	01	H4161_007_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	255.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4161	009	0	1	02	01	H4161_009_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H4161	010	0	1	02	01	H4161_010_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H4161	011	0	1	02	01	H4161_011_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	140.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001101	1																																		1		1	1
H4161	012	0	1	02	01	H4161_012_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	115.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001101	1																																		1		1	1
H4161	013	0	1	02	01	H4161_013_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	135.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001101	1																																		1		1	1
H4161	014	0	1	02	01	H4161_014_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4161	015	0	1	02	01	H4161_015_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4161	016	0	1	02	01	H4161_016_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4161	017	0	1	02	01	H4161_017_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4172	001	0	1	01	01	H4172_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H4172	003	0	1	01	01	H4172_003_0	6			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H4185	001	0	1	20	08	H4185_001_0	2				1																																																																				
H4185	002	0	1	20	08	H4185_002_0	2				1																																																																				
H4193	001	0	1	01	01	H4193_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	102	01	30		111	30	60	102	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4203	001	0	1	20	08	H4203_001_0	2				1																																																																				
H4203	002	0	1	20	08	H4203_002_0	2				1																																																																				
H4213	017	1	1	09	04	H4213_017_1	5			5F	1	3	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H4213	017	5	1	09	04	H4213_017_5	5			5F	1	3	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H4213	017	6	1	09	04	H4213_017_6	5			5F	1	3	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H4213	019	0	1	09	04	H4213_019_0	3	N	N		2																																																																				
H4213	801	0	1	09	04	H4213_801_0	2				1																																																																				
H4213	802	0	1	09	04	H4213_802_0	2				1																																																																				
H4213	803	0	1	09	04	H4213_803_0	2	N	N		2																																																																				
H4213	804	0	1	09	04	H4213_804_0	2	N	N		2																																																																				
H4227	001	0	1	01	01	H4227_001_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H4227	002	0	1	01	01	H4227_002_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H4232	001	0	1	01	01	H4232_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4232	003	0	1	01	01	H4232_003_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4235	001	0	1	20	08	H4235_001_0	2				1																																																																				
H4235	002	0	1	20	08	H4235_002_0	2				1																																																																				
H4256	001	0	1	20	08	H4256_001_0	2				1																																																																				
H4256	002	0	1	20	08	H4256_002_0	2				1																																																																				
H4279	001	0	1	01	01	H4279_001_0	17		N	5F	1	2	110110	1		1	1	5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1	1	1	1
H4279	004	0	1	01	01	H4279_004_0	18		N	5F	1	2	110110	1		1	1	5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1	1	1	1
H4286	001	0	1	01	01	H4286_001_0	6			4H1	1	4	101100	1	2	2		5	3	1	1			Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	We have reduced the deductible down to zero and are offering copays on Tiers 1-4 with cost-sharing amounts that are lower than the Defined Standard for this phase	1	3		0111000	3																																				1	1
H4286	002	0	1	01	01	H4286_002_0	6		N	4H1	1	4	101100	1	2	2		5	3	2				Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0000010	1				1	1	101	The coinsurance on Tier 1 and Tier 2 are offered at 20%, which is lower than the defined standard benefit, providing reduced cost share to the member in this phase.  In aggregate across all tiers, the actuarial value of the benefit exceeds defined standard coverage.	1	3		0111000	1																																		1	1	1	1
H4286	003	0	1	01	01	H4286_003_0	6			4H1	1	4	101100	1	2	2		5	3	1	1			Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	We have reduced the deductible down to zero and are offering copays on Tiers 1-4 with cost-sharing amounts that are lower than the Defined Standard for this phase.	1	3		0111000	3																																				1	1
H4286	005	0	1	01	01	H4286_005_0	6		N	4H1	1	4	101100	1	2	2		5	3	2				Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0000010	1				1	1	101	The coinsurance on Tier 1 and Tier 2 are offered at 20%, which is lower than the defined standard benefit, providing reduced cost share to the member in this phase.  In aggregate across all tiers, the actuarial value of the benefit exceeds defined standard coverage.	1	3		0111000	1																																		1	1	1	1
H4305	001	0	1	20	08	H4305_001_0	2				1																																																																				
H4305	002	0	1	20	08	H4305_002_0	2				1																																																																				
H4326	001	0	1	20	08	H4326_001_0	2				1																																																																				
H4326	002	0	1	20	08	H4326_002_0	2				1																																																																				
H4329	001	0	1	01	01	H4329_001_0	3		N	5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	390.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1	1	1	1
H4346	001	0	1	02	01	H4346_001_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	95.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4346	005	0	1	02	01	H4346_005_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4346	006	0	1	02	01	H4346_006_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4346	010	0	1	01	01	H4346_010_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.	2	3		0001101	1																																		1		1	1
H4346	012	0	1	01	01	H4346_012_0	7			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	325.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4346	014	0	1	01	01	H4346_014_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4346	017	0	1	02	01	H4346_017_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	50.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H4346	025	0	1	01	01	H4346_025_0	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4346	030	0	1	02	01	H4346_030_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H4346	031	0	1	01	01	H4346_031_0	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4346	805	0	1	01	01	H4346_805_0	3				1																																																																				
H4346	806	0	2	01	01	H4346_806_0	3				1																																																																				
H4346	809	0	1	01	01	H4346_809_0	4	N	N		2																																																																				
H4346	810	0	2	01	01	H4346_810_0	4	N	N		2																																																																				
H4346	812	0	1	01	01	H4346_812_0	4	N	N		2																																																																				
H4346	821	0	2	01	01	H4346_821_0	4	N	N		2																																																																				
H4346	823	0	1	01	01	H4346_823_0	4				1																																																																				
H4346	824	0	1	01	01	H4346_824_0	4	N	N		2																																																																				
H4346	826	0	1	01	01	H4346_826_0	4	N	N		2																																																																				
H4346	827	0	2	01	01	H4346_827_0	4				1																																																																				
H4346	828	0	2	01	01	H4346_828_0	4	N	N		2																																																																				
H4346	830	0	2	01	01	H4346_830_0	4	N	N		2																																																																				
H4348	001	0	1	04	01	H4348_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4348	002	0	1	04	01	H4348_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4348	003	0	1	04	01	H4348_003_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H4348	004	0	1	04	01	H4348_004_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H4348	005	0	1	04	01	H4348_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4348	006	0	1	04	01	H4348_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4348	007	0	1	04	01	H4348_007_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H4371	001	0	1	01	01	H4371_001_0	9		N		1	1	110110	1		2											615.00																111	31	60	100	01	31		111	31	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4393	001	0	1	20	08	H4393_001_0	2				1																																																																				
H4393	002	0	1	20	08	H4393_002_0	2				1																																																																				
H4402	001	0	1	20	08	H4402_001_0	2				1																																																																				
H4402	002	0	1	20	08	H4402_002_0	2				1																																																																				
H4407	004	0	1	01	01	H4407_004_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4407	011	0	1	01	01	H4407_011_0	3	N	N		2																																																																				
H4407	027	0	1	01	01	H4407_027_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4407	029	0	1	01	01	H4407_029_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4407	030	1	1	01	01	H4407_030_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4407	030	2	1	01	01	H4407_030_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4407	030	3	1	01	01	H4407_030_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4407	033	0	1	01	01	H4407_033_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4407	034	0	1	01	01	H4407_034_0	5			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H4407	035	0	1	01	01	H4407_035_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4439	001	0	1	01	01	H4439_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4439	002	0	1	01	01	H4439_002_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4439	003	0	1	01	01	H4439_003_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4444	001	0	1	01	01	H4444_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4444	002	0	1	01	01	H4444_002_0	8				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4444	003	0	1	01	01	H4444_003_0	7				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4461	004	0	1	01	01	H4461_004_0	1	N	N		2																																																																				
H4461	022	0	1	01	01	H4461_022_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	025	0	1	01	01	H4461_025_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	035	0	1	01	01	H4461_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	038	0	1	01	01	H4461_038_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	039	0	1	01	01	H4461_039_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	565.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	040	0	1	01	01	H4461_040_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	041	0	1	01	01	H4461_041_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	042	0	1	01	01	H4461_042_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H4461	043	1	1	01	01	H4461_043_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	043	2	1	01	01	H4461_043_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	044	0	1	02	01	H4461_044_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H4461	045	0	1	01	01	H4461_045_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	046	0	1	01	01	H4461_046_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	047	0	1	02	01	H4461_047_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	048	0	1	02	01	H4461_048_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	049	0	1	01	01	H4461_049_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	050	0	1	01	01	H4461_050_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	051	0	1	01	01	H4461_051_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	052	0	1	01	01	H4461_052_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	053	0	1	01	01	H4461_053_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	054	0	1	01	01	H4461_054_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	055	0	1	01	01	H4461_055_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	056	0	1	01	01	H4461_056_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	057	0	1	01	01	H4461_057_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	058	0	1	01	01	H4461_058_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	059	0	1	01	01	H4461_059_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	060	0	1	01	01	H4461_060_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	061	0	1	01	01	H4461_061_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	062	0	1	01	01	H4461_062_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	063	0	1	01	01	H4461_063_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H4461	064	0	1	01	01	H4461_064_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	065	0	1	01	01	H4461_065_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H4461	066	0	1	01	01	H4461_066_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H4461	067	0	1	01	01	H4461_067_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H4461	068	0	1	01	01	H4461_068_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H4461	069	0	1	01	01	H4461_069_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	070	0	1	01	01	H4461_070_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	265.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	071	0	1	01	01	H4461_071_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	072	0	1	01	01	H4461_072_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	290.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	073	0	1	01	01	H4461_073_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	074	0	1	01	01	H4461_074_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	565.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	075	0	1	01	01	H4461_075_0	1	N	N		2																																																																				
H4461	076	0	1	01	01	H4461_076_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	077	0	1	01	01	H4461_077_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	540.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4461	078	0	1	01	01	H4461_078_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4461	079	0	1	01	01	H4461_079_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H4461	806	0	1	01	01	H4461_806_0	1				1																																																																				
H4461	807	0	1	01	01	H4461_807_0	1	N	N		2																																																																				
H4461	810	0	1	01	01	H4461_810_0	1				1																																																																				
H4461	811	0	1	01	01	H4461_811_0	1	N	N		2																																																																				
H4471	005	0	1	01	01	H4471_005_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	105.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4471	010	1	1	01	01	H4471_010_1	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4471	010	2	1	01	01	H4471_010_2	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4471	011	0	1	01	01	H4471_011_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4473	001	0	1	04	01	H4473_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4473	002	0	1	04	01	H4473_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4473	003	0	1	04	01	H4473_003_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H4473	004	0	1	04	01	H4473_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H4473	007	0	1	04	01	H4473_007_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H4490	001	0	1	01	01	H4490_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4490	003	0	1	01	01	H4490_003_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4497	001	1	1	04	01	H4497_001_1	15			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	95.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	001	3	1	04	01	H4497_001_3	15			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	95.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	002	1	1	04	01	H4497_002_1	15			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	002	3	1	04	01	H4497_002_3	15			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	003	1	1	04	01	H4497_003_1	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	003	3	1	04	01	H4497_003_3	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	005	3	1	04	01	H4497_005_3	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	005	4	1	04	01	H4497_005_4	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H4497	801	0	1	04	01	H4497_801_0	9				1																																																																				
H4497	802	0	1	04	01	H4497_802_0	9				1																																																																				
H4497	803	0	1	04	01	H4497_803_0	9	N	N		2																																																																				
H4499	001	0	1	01	01	H4499_001_0	7		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H4506	003	0	1	02	01	H4506_003_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4506	010	0	1	02	01	H4506_010_0	8	N	N		2																																																																				
H4506	030	0	1	02	01	H4506_030_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4513	009	0	1	01	01	H4513_009_0	2	N	N		2																																																																				
H4513	026	0	1	01	01	H4513_026_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	027	0	1	01	01	H4513_027_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	030	0	1	01	01	H4513_030_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	033	0	1	01	01	H4513_033_0	3	N	N		2																																																																				
H4513	034	0	1	01	01	H4513_034_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	035	0	1	01	01	H4513_035_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4513	036	0	1	02	01	H4513_036_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	037	0	1	01	01	H4513_037_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	038	0	1	01	01	H4513_038_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	039	0	1	01	01	H4513_039_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	045	0	1	01	01	H4513_045_0	3	N	N		2																																																																				
H4513	046	1	1	01	01	H4513_046_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	046	2	1	01	01	H4513_046_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	049	1	1	01	01	H4513_049_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	049	2	1	01	01	H4513_049_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	049	3	1	01	01	H4513_049_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	049	4	1	01	01	H4513_049_4	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	049	5	1	01	01	H4513_049_5	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	050	0	1	01	01	H4513_050_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	052	0	1	01	01	H4513_052_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	053	0	1	01	01	H4513_053_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4513	055	0	1	01	01	H4513_055_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	060	1	1	01	01	H4513_060_1	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	060	2	1	01	01	H4513_060_2	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	060	3	1	01	01	H4513_060_3	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	060	4	1	01	01	H4513_060_4	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	060	5	1	01	01	H4513_060_5	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	061	1	1	01	01	H4513_061_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	061	2	1	01	01	H4513_061_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	061	3	1	01	01	H4513_061_3	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	061	4	1	01	01	H4513_061_4	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	061	5	1	01	01	H4513_061_5	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	063	0	1	01	01	H4513_063_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	064	0	1	01	01	H4513_064_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	068	1	1	01	01	H4513_068_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	068	2	1	01	01	H4513_068_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	068	3	1	01	01	H4513_068_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	073	0	1	01	01	H4513_073_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	074	0	1	01	01	H4513_074_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	075	0	1	01	01	H4513_075_0	4		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	077	1	1	01	01	H4513_077_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	077	2	1	01	01	H4513_077_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	077	3	1	01	01	H4513_077_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	077	4	1	01	01	H4513_077_4	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	078	0	1	01	01	H4513_078_0	3	N	N		2																																																																				
H4513	079	0	1	01	01	H4513_079_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	080	0	1	01	01	H4513_080_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	081	0	1	01	01	H4513_081_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H4513	083	1	1	01	01	H4513_083_1	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	2	1	01	01	H4513_083_2	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	3	1	01	01	H4513_083_3	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	4	1	01	01	H4513_083_4	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	5	1	01	01	H4513_083_5	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	6	1	01	01	H4513_083_6	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	083	7	1	01	01	H4513_083_7	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	084	0	1	02	01	H4513_084_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	085	0	1	01	01	H4513_085_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	086	0	1	01	01	H4513_086_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	087	1	1	01	01	H4513_087_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	087	2	1	01	01	H4513_087_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	087	3	1	01	01	H4513_087_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	087	4	1	01	01	H4513_087_4	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	088	0	1	01	01	H4513_088_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	089	0	1	01	01	H4513_089_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	090	0	1	01	01	H4513_090_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	091	0	1	01	01	H4513_091_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	092	0	1	01	01	H4513_092_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	093	0	1	01	01	H4513_093_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	094	0	1	01	01	H4513_094_0	5			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H4513	095	0	1	01	01	H4513_095_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	096	0	1	02	01	H4513_096_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H4513	097	0	1	01	01	H4513_097_0	5			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H4513	098	0	1	01	01	H4513_098_0	4			5F3	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111111	3																																		1		1	1
H4513	804	0	1	01	01	H4513_804_0	2				1																																																																				
H4513	815	0	1	01	01	H4513_815_0	2				1																																																																				
H4513	817	0	1	01	01	H4513_817_0	2				1																																																																				
H4513	819	0	1	01	01	H4513_819_0	2				1																																																																				
H4513	821	0	1	01	01	H4513_821_0	2				1																																																																				
H4514	007	0	1	02	01	H4514_007_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4514	014	0	1	02	01	H4514_014_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4514	015	0	1	02	01	H4514_015_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4514	016	0	1	02	01	H4514_016_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	149.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4514	017	0	1	02	01	H4514_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4514	018	0	1	02	01	H4514_018_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	266.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4514	021	0	1	02	01	H4514_021_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H4514	022	0	1	02	01	H4514_022_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4514	023	0	1	02	01	H4514_023_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	532.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4514	024	0	1	02	01	H4514_024_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	503.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4514	801	0	1	01	01	H4514_801_0	1				1																																																																				
H4514	803	0	1	01	01	H4514_803_0	1	N	N		2																																																																				
H4514	806	0	1	01	01	H4514_806_0	1				1																																																																				
H4517	001	0	1	20	08	H4517_001_0	2				1																																																																				
H4517	002	0	1	20	08	H4517_002_0	2				1																																																																				
H4518	001	0	1	20	08	H4518_001_0	2				1																																																																				
H4518	002	0	1	20	08	H4518_002_0	2				1																																																																				
H4523	001	0	1	01	01	H4523_001_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	015	0	1	01	01	H4523_015_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	020	0	1	01	01	H4523_020_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	021	0	1	01	01	H4523_021_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	024	0	1	01	01	H4523_024_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	027	0	1	01	01	H4523_027_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	028	0	1	01	01	H4523_028_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	029	0	1	01	01	H4523_029_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	030	0	1	01	01	H4523_030_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	031	0	1	01	01	H4523_031_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	034	0	1	01	01	H4523_034_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	037	0	1	01	01	H4523_037_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	038	0	1	01	01	H4523_038_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	039	0	1	01	01	H4523_039_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	041	0	1	01	01	H4523_041_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	042	0	1	01	01	H4523_042_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4523	043	0	1	01	01	H4523_043_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	044	0	1	01	01	H4523_044_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4523	801	0	1	01	01	H4523_801_0	1	N	N		2																																																																				
H4523	802	0	1	01	01	H4523_802_0	1				1																																																																				
H4527	001	0	1	02	01	H4527_001_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	002	0	1	02	01	H4527_002_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	003	0	1	02	01	H4527_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	417.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4527	005	0	1	02	01	H4527_005_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	013	0	1	02	01	H4527_013_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	015	0	1	02	01	H4527_015_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	122.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4527	024	0	1	02	01	H4527_024_0	3	N	N		2																																																																				
H4527	037	0	1	02	01	H4527_037_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	039	0	1	02	01	H4527_039_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	040	0	1	02	01	H4527_040_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	041	0	1	02	01	H4527_041_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	042	0	1	02	01	H4527_042_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	045	0	1	02	01	H4527_045_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	048	0	1	02	01	H4527_048_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	051	0	1	02	01	H4527_051_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	203.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	052	0	1	02	01	H4527_052_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	053	0	1	02	01	H4527_053_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	054	0	1	02	01	H4527_054_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	257.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4527	055	0	1	02	01	H4527_055_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	056	0	1	02	01	H4527_056_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	057	0	1	02	01	H4527_057_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4527	058	0	1	02	01	H4527_058_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	059	0	1	02	01	H4527_059_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4527	801	0	1	01	01	H4527_801_0	1				1																																																																				
H4527	802	0	1	01	01	H4527_802_0	1	N	N		2																																																																				
H4527	803	0	1	01	01	H4527_803_0	1				1																																																																				
H4537	001	0	1	04	01	H4537_001_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4537	004	0	1	04	01	H4537_004_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	455.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4537	005	0	1	04	01	H4537_005_0	8	N	N		2																																																																				
H4538	003	0	1	20	08	H4538_003_0	2				1																																																																				
H4538	004	0	1	20	08	H4538_004_0	2				1																																																																				
H4544	001	0	1	04	01	H4544_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4544	002	0	1	04	01	H4544_002_0	3	N	N		2																																																																				
H4545	001	0	1	20	08	H4545_001_0	2				1																																																																				
H4545	002	0	1	20	08	H4545_002_0	2				1																																																																				
H4604	003	0	1	02	01	H4604_003_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	005	0	1	02	01	H4604_005_0	3	N	N		2																																																																				
H4604	011	0	1	02	01	H4604_011_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	012	0	1	02	01	H4604_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	013	0	1	02	01	H4604_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	014	0	1	02	01	H4604_014_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	016	0	1	02	01	H4604_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	017	0	1	02	01	H4604_017_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	018	0	1	02	01	H4604_018_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	019	0	1	02	01	H4604_019_0	3	N	N		2																																																																				
H4604	020	0	1	02	01	H4604_020_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	022	0	1	02	01	H4604_022_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	024	0	1	02	01	H4604_024_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	025	0	1	02	01	H4604_025_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	026	0	1	02	01	H4604_026_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H4604	027	0	1	02	01	H4604_027_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	028	0	1	02	01	H4604_028_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H4604	801	0	1	01	01	H4604_801_0	1				1																																																																				
H4604	803	0	1	01	01	H4604_803_0	1				1																																																																				
H4604	805	0	1	01	01	H4604_805_0	1	N	N		2																																																																				
H4604	809	0	1	01	01	H4604_809_0	1				1																																																																				
H4604	810	0	1	01	01	H4604_810_0	1				1																																																																				
H4604	811	0	1	01	01	H4604_811_0	1	N	N		2																																																																				
H4605	001	0	1	04	01	H4605_001_0	5	N	N		2																																																																				
H4605	002	0	1	04	01	H4605_002_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	495.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H4605	004	0	1	04	01	H4605_004_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H4605	801	0	1	04	01	H4605_801_0	3	N	N		2																																																																				
H4605	802	0	1	04	01	H4605_802_0	3				1																																																																				
H4605	803	0	1	04	01	H4605_803_0	3				1																																																																				
H4605	804	0	1	04	01	H4605_804_0	3				1																																																																				
H4610	001	0	1	01	01	H4610_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	534.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H4610	002	0	1	01	01	H4610_002_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H4623	001	0	1	02	01	H4623_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4623	002	0	1	02	01	H4623_002_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H4624	001	0	1	01	01	H4624_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	003	0	1	01	01	H4624_003_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	006	0	1	01	01	H4624_006_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	010	0	1	01	01	H4624_010_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	011	0	1	01	01	H4624_011_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	012	0	1	01	01	H4624_012_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	022	0	1	01	01	H4624_022_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	023	0	1	01	01	H4624_023_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	025	0	1	01	01	H4624_025_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	026	0	1	01	01	H4624_026_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	027	0	1	01	01	H4624_027_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	The plan fulfills this through reduced cost sharing on Tier 1 to $0 copay.	1	3		0101111	1																																		1		1	1
H4624	028	0	1	01	01	H4624_028_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	029	0	1	01	01	H4624_029_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	031	0	1	01	01	H4624_031_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	032	0	1	01	01	H4624_032_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	033	0	1	01	01	H4624_033_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	034	0	1	01	01	H4624_034_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	036	0	1	01	01	H4624_036_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	037	0	1	01	01	H4624_037_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	038	0	1	01	01	H4624_038_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	039	0	1	01	01	H4624_039_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	040	0	1	01	01	H4624_040_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	042	0	1	01	01	H4624_042_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4624	043	0	1	01	01	H4624_043_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	044	0	1	01	01	H4624_044_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H4624	045	0	1	01	01	H4624_045_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	For Tier 1, we are placing the cost share at 15%, not to exceed the 25%.	2	3		0101110	1																																		1		1	1
H4624	046	0	1	01	01	H4624_046_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H4626	001	0	1	20	08	H4626_001_0	2				1																																																																				
H4626	002	0	1	20	08	H4626_002_0	2				1																																																																				
H4647	001	0	1	01	01	H4647_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	The plan has a $0 deductible on Tier 1 and Tier 2, a $250 deductible on Tiers 3, 4, and 5, and low copays.	1	3		0111110	1																																		1		1	1
H4647	002	0	1	01	01	H4647_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	111	The plan has $0 deductible on Tier 1 and Tier 2, a $250 deductible on Tiers 3, 4, and 5, and low copays.	1	3		0111110	1																																		1		1	1
H4661	001	0	1	02	01	H4661_001_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4661	003	0	1	02	01	H4661_003_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	475.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4661	005	0	1	02	01	H4661_005_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H4676	001	0	1	01	01	H4676_001_0	7			5F2	1	4	101100	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	There is no deductible.  There are copays on Tiers 1-4.	2	3		0011100	1																																				1	1
H4676	002	0	1	01	01	H4676_002_0	7		N	5F2	1	4	110100	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0100001	1				1	1	101	There are no copays for tier 1.	2	3		0011100	1																																		1	1	1	1
H4694	001	0	1	01	01	H4694_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4694	002	0	1	01	01	H4694_002_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	605.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4694	003	0	1	01	01	H4694_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4694	004	0	1	01	01	H4694_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4704	001	0	1	04	01	H4704_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4704	002	0	1	04	01	H4704_002_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H4711	001	0	1	01	01	H4711_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4711	002	0	1	01	01	H4711_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4711	005	0	1	01	01	H4711_005_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4711	008	0	1	02	01	H4711_008_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4711	010	0	1	02	01	H4711_010_0	2	N	N		2																																																																				
H4711	011	0	1	01	01	H4711_011_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4711	012	0	1	01	01	H4711_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4711	013	0	1	01	01	H4711_013_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H4711	801	0	1	01	01	H4711_801_0	1	N	N		2																																																																				
H4714	001	0	1	20	08	H4714_001_0	2				1																																																																				
H4714	002	0	1	20	08	H4714_002_0	2				1																																																																				
H4733	001	0	1	01	01	H4733_001_0	5		N	5A4	1	2	110110	1		2		6	4	2		1	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1		615.00														0111111																																			1		1	1
H4739	001	0	1	01	01	H4739_001_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H4754	004	0	1	04	01	H4754_004_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	499.00	2	0110000	1				2	1	111	The Part D benefit is enhanced beyond the defined standard benefit through a lower deductible (on some plans), exemption of some cost-sharing tiers from the deductible, and copays on some cost-sharing tiers that are effectively lower than the defined standard’s 25% coinsurance.	2	3		0001010	1																																		1		1	1
H4754	006	0	1	04	01	H4754_006_0	5	N	N		2																																																																				
H4754	801	0	1	04	01	H4754_801_0	4	N	N		2																																																																				
H4754	802	0	1	04	01	H4754_802_0	4				1																																																																				
H4808	001	0	1	04	01	H4808_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4808	002	0	1	04	01	H4808_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	405.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4808	003	0	1	04	01	H4808_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4808	004	0	1	04	01	H4808_004_0	4	N	N		2																																																																				
H4808	005	0	1	04	01	H4808_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H4835	001	0	1	01	01	H4835_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4835	002	0	1	01	01	H4835_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4835	801	0	1	01	01	H4835_801_0	1	N	N		2																																																																				
H4847	001	0	1	02	01	H4847_001_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4847	005	0	1	02	01	H4847_005_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	475.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H4847	006	0	1	02	01	H4847_006_0	8	N	N		2																																																																				
H4847	007	0	1	02	01	H4847_007_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4868	003	0	1	02	01	H4868_003_0	8	N	N		2																																																																				
H4868	004	0	1	01	01	H4868_004_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	410.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4868	014	0	1	01	01	H4868_014_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H4868	016	0	1	02	01	H4868_016_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	590.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H4868	019	0	1	02	01	H4868_019_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H4869	001	0	1	02	01	H4869_001_0	4			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tiers 1 and 2, and reduced copays on tiers 3-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H4869	003	0	1	02	01	H4869_003_0	5			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tier 1, and reduced copays on tiers 2-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H4869	011	0	1	02	01	H4869_011_0	4			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tiers 1 and 2, and reduced copays on tiers 3-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H4869	013	0	1	02	01	H4869_013_0	5			5A3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	110	This plan offers a $0 deductible, no cost sharing on tier 1, and reduced copays on tiers 2-4 below the defined standard cost sharing.	2	3		0000101	1																																				1	1
H4869	014	0	1	02	01	H4869_014_0	6				1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H4875	016	1	1	04	01	H4875_016_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H4875	016	2	1	04	01	H4875_016_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H4875	016	3	1	04	01	H4875_016_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H4875	016	4	1	04	01	H4875_016_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H4875	016	5	1	04	01	H4875_016_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H4875	018	1	1	04	01	H4875_018_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	018	2	1	04	01	H4875_018_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	018	3	1	04	01	H4875_018_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	018	4	1	04	01	H4875_018_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	018	5	1	04	01	H4875_018_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	020	1	1	04	01	H4875_020_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	020	2	1	04	01	H4875_020_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	020	3	1	04	01	H4875_020_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	022	1	1	04	01	H4875_022_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	022	2	1	04	01	H4875_022_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	022	5	1	04	01	H4875_022_5	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				1	1	011		2	3		0001110	1																																		1		1	1
H4875	024	1	1	04	01	H4875_024_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	024	2	1	04	01	H4875_024_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H4875	803	0	1	04	01	H4875_803_0	3				1																																																																				
H4875	804	0	1	04	01	H4875_804_0	3				1																																																																				
H4875	805	0	1	04	01	H4875_805_0	3	N	N		2																																																																				
H4875	806	0	1	04	01	H4875_806_0	3	N	N		2																																																																				
H4875	807	0	1	04	01	H4875_807_0	3				1																																																																				
H4875	808	0	1	04	01	H4875_808_0	3				1																																																																				
H4875	809	0	1	04	01	H4875_809_0	3				1																																																																				
H4875	810	0	1	04	01	H4875_810_0	3				1																																																																				
H4882	003	0	1	04	01	H4882_003_0	8			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	009	1	1	04	01	H4882_009_1	11			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	009	2	1	04	01	H4882_009_2	10			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	011	1	1	04	01	H4882_011_1	9			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	011	2	1	04	01	H4882_011_2	8			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	014	1	1	04	01	H4882_014_1	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	014	2	1	04	01	H4882_014_2	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H4882	801	0	1	04	01	H4882_801_0	3				1																																																																				
H4882	803	0	1	04	01	H4882_803_0	2	N	N		2																																																																				
H4882	804	0	1	04	01	H4882_804_0	2				1																																																																				
H4882	805	0	1	04	01	H4882_805_0	2	N	N		2																																																																				
H4882	806	0	1	04	01	H4882_806_0	2				1																																																																				
H4909	014	0	1	04	01	H4909_014_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4909	020	0	1	04	01	H4909_020_0	4	N	N		2																																																																				
H4909	021	0	1	04	01	H4909_021_0	6	N	N		2																																																																				
H4909	023	0	1	04	01	H4909_023_0	4	N	N		2																																																																				
H4909	026	0	1	04	01	H4909_026_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	215.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H4909	804	0	1	04	01	H4909_804_0	4				1																																																																				
H4909	805	0	1	04	01	H4909_805_0	4	N	N		2																																																																				
H4909	810	0	2	04	01	H4909_810_0	4				1																																																																				
H4909	811	0	1	04	01	H4909_811_0	4				1																																																																				
H4909	812	0	1	04	01	H4909_812_0	4	N	N		2																																																																				
H4909	814	0	2	04	01	H4909_814_0	4	N	N		2																																																																				
H4909	815	0	2	04	01	H4909_815_0	4	N	N		2																																																																				
H4909	817	0	1	04	01	H4909_817_0	4	N	N		2																																																																				
H4909	818	0	1	04	01	H4909_818_0	4	N	N		2																																																																				
H4919	001	0	1	20	08	H4919_001_0	2				1																																																																				
H4919	002	0	1	20	08	H4919_002_0	2				1																																																																				
H4931	007	0	1	01	01	H4931_007_0	7		N		1	1	110110	1		2											615.00																110	31		90	01	31		110	31		90	1	31	2	2	35.00		105.00	35.00		70.00	35.00		35.00	25		25	25		25	25		25			1	1
H4931	015	0	1	01	01	H4931_015_0	7		N		1	1	110110	1		2											615.00																110	31		90	01	31		110	31		90	1	31	2	2	35.00		105.00	35.00		70.00	35.00		35.00	25		25	25		25	25		25			1	1
H4937	801	0	1	04	01	H4937_801_0	4				1																																																																				
H4937	802	0	1	04	01	H4937_802_0	4				1																																																																				
H4937	803	0	1	04	01	H4937_803_0	4	N	N		2																																																																				
H4937	804	0	1	04	01	H4937_804_0	4	N	N		2																																																																				
H4937	805	0	1	04	01	H4937_805_0	4				1																																																																				
H4937	806	0	2	04	01	H4937_806_0	4				1																																																																				
H4937	807	0	2	04	01	H4937_807_0	4				1																																																																				
H4939	001	0	1	02	01	H4939_001_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4939	002	0	1	02	01	H4939_002_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4939	003	0	1	02	01	H4939_003_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H4961	001	0	1	04	01	H4961_001_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H4961	003	0	1	04	01	H4961_003_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H4961	006	0	1	04	01	H4961_006_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H4961	801	0	1	04	01	H4961_801_0	1				1																																																																				
H4961	802	0	1	04	01	H4961_802_0	1				1																																																																				
H4961	803	0	1	04	01	H4961_803_0	1	N	N		2																																																																				
H4961	804	0	1	04	01	H4961_804_0	1	N	N		2																																																																				
H4982	001	0	1	01	01	H4982_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	002	0	1	01	01	H4982_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	003	0	1	01	01	H4982_003_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	004	0	1	01	01	H4982_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	007	0	1	01	01	H4982_007_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	022	0	1	02	01	H4982_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	025	0	1	02	01	H4982_025_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	026	0	1	02	01	H4982_026_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	030	0	1	02	01	H4982_030_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H4982	801	0	1	01	01	H4982_801_0	1	N	N		2																																																																				
H4999	001	0	1	20	08	H4999_001_0	2				1																																																																				
H4999	002	0	1	20	08	H4999_002_0	2				1																																																																				
H5007	001	0	1	20	08	H5007_001_0	2				1																																																																				
H5007	002	0	1	20	08	H5007_002_0	2				1																																																																				
H5008	002	0	1	02	01	H5008_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	010	0	1	02	01	H5008_010_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	011	0	1	02	01	H5008_011_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	015	0	1	02	01	H5008_015_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	016	0	1	02	01	H5008_016_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	017	0	1	02	01	H5008_017_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	018	0	1	02	01	H5008_018_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5008	019	0	1	02	01	H5008_019_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	532.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H5008	020	0	1	02	01	H5008_020_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5009	002	0	1	04	01	H5009_002_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5009	011	1	1	04	01	H5009_011_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		2	3		0111100	1																																		1		1	1
H5009	011	2	1	04	01	H5009_011_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		2	3		0111100	1																																		1		1	1
H5009	801	0	1	04	01	H5009_801_0	3	N	N		2																																																																				
H5009	802	0	1	04	01	H5009_802_0	3				1																																																																				
H5009	803	0	1	04	01	H5009_803_0	3				1																																																																				
H5009	804	0	1	04	01	H5009_804_0	3				1																																																																				
H5015	001	0	1	01	01	H5015_001_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5015	002	0	1	01	01	H5015_002_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5037	001	0	1	20	08	H5037_001_0	3				1																																																																				
H5037	002	0	1	20	08	H5037_002_0	3				1																																																																				
H5042	801	0	1	04	01	H5042_801_0	5				1																																																																				
H5042	802	0	1	04	01	H5042_802_0	5				1																																																																				
H5042	803	0	1	04	01	H5042_803_0	5	N	N		2																																																																				
H5050	001	0	1	01	01	H5050_001_0	3	N	N		2																																																																				
H5050	004	0	1	01	01	H5050_004_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	009	0	1	01	01	H5050_009_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	017	0	1	01	01	H5050_017_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	100.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	019	0	1	01	01	H5050_019_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	021	0	1	01	01	H5050_021_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	022	0	1	01	01	H5050_022_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	023	0	1	01	01	H5050_023_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	110.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	024	0	1	01	01	H5050_024_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	025	0	1	01	01	H5050_025_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	026	0	1	01	01	H5050_026_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	027	0	1	01	01	H5050_027_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	028	0	1	01	01	H5050_028_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	029	0	1	01	01	H5050_029_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	030	0	1	01	01	H5050_030_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	031	0	1	01	01	H5050_031_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	032	0	1	01	01	H5050_032_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H5050	801	0	1	01	01	H5050_801_0	3	N	N		2																																																																				
H5050	802	0	1	01	01	H5050_802_0	3				1																																																																				
H5080	001	0	1	20	08	H5080_001_0	2				1																																																																				
H5080	002	0	1	20	08	H5080_002_0	2				1																																																																				
H5085	003	0	1	20	08	H5085_003_0	2				1																																																																				
H5085	004	0	1	20	08	H5085_004_0	2				1																																																																				
H5087	005	0	1	01	01	H5087_005_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5087	032	0	1	01	01	H5087_032_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5087	034	1	1	01	01	H5087_034_1	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5087	034	2	1	01	01	H5087_034_2	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5106	029	1	1	04	01	H5106_029_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	029	2	1	04	01	H5106_029_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	029	3	1	04	01	H5106_029_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	030	1	1	04	01	H5106_030_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	030	2	1	04	01	H5106_030_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	030	3	1	04	01	H5106_030_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	034	1	1	04	01	H5106_034_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H5106	034	2	1	04	01	H5106_034_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The enhanced alternative plan provides members with access to all pharmaceuticals without deductible, and a low predictable Tier 1 & 2 copay level.	2	3		0001100	1																																				1	1
H5106	035	0	1	04	01	H5106_035_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	036	0	1	04	01	H5106_036_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	037	0	1	04	01	H5106_037_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5106	038	0	1	04	01	H5106_038_0	4	N	N		2																																																																				
H5106	806	0	1	04	01	H5106_806_0	1				1																																																																				
H5106	807	0	1	04	01	H5106_807_0	1	N	N		2																																																																				
H5106	808	0	1	04	01	H5106_808_0	1				1																																																																				
H5106	810	0	1	04	01	H5106_810_0	1				1																																																																				
H5117	801	0	1	01	01	H5117_801_0	3				1																																																																				
H5119	001	0	1	01	01	H5119_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Plan has waived the deductible for Tiers 1 & 6, Reduced cost sharing to $0 for both Tiers 1 & 6.	2	3		0011100	1																																		1	1	1	1
H5124	001	0	1	20	08	H5124_001_0	2				1																																																																				
H5124	002	0	1	20	08	H5124_002_0	2				1																																																																				
H5141	004	0	1	04	01	H5141_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	007	0	1	04	01	H5141_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	220.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																		1		1	1
H5141	025	0	1	04	01	H5141_025_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	026	0	1	04	01	H5141_026_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	032	0	1	04	01	H5141_032_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	036	0	1	04	01	H5141_036_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	038	0	1	04	01	H5141_038_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	042	0	1	04	01	H5141_042_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																		1		1	1
H5141	045	0	1	04	01	H5141_045_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																		1		1	1
H5141	054	0	1	04	01	H5141_054_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	056	0	1	04	01	H5141_056_0	4	N	N		2																																																																				
H5141	061	0	1	04	01	H5141_061_0	6	N	N		2																																																																				
H5141	062	0	1	04	01	H5141_062_0	6	N	N		2																																																																				
H5141	063	0	1	04	01	H5141_063_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H5141	801	0	1	04	01	H5141_801_0	2				1																																																																				
H5163	001	0	1	01	01	H5163_001_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H5163	002	0	1	01	01	H5163_002_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H5163	003	0	1	01	01	H5163_003_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H5163	004	0	1	01	01	H5163_004_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	By offering lower cost sharing than the defined standard prescription drug coverage on tiers 1 and 2, we are increasing the actuarial value of the benefits above where it would be under the defined standard prescription drug coverage.	1	3		0111111	1																																		1		1	1
H5167	001	0	1	20	08	H5167_001_0	3				1																																																																				
H5167	002	0	1	20	08	H5167_002_0	3				1																																																																				
H5178	002	0	1	01	01	H5178_002_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5190	801	0	1	01	01	H5190_801_0	3				1																																																																				
H5209	005	1	1	01	01	H5209_005_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1 , 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5209	005	2	1	01	01	H5209_005_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1 , 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5209	006	1	1	01	01	H5209_006_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5209	006	2	1	01	01	H5209_006_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5211	001	0	1	02	01	H5211_001_0	9	N	N		2																																																																				
H5211	002	0	1	02	01	H5211_002_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	330.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5211	003	0	1	02	01	H5211_003_0	9	N	N		2																																																																				
H5211	004	0	1	02	01	H5211_004_0	11			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5211	010	0	1	01	01	H5211_010_0	11		N		1	1	110110	1		2											615.00																111	34	68	102	01	34		111	34	68	102	1	34	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5211	012	0	1	02	01	H5211_012_0	11			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5212	001	0	1	20	08	H5212_001_0	2				1																																																																				
H5212	002	0	1	20	08	H5212_002_0	2				1																																																																				
H5213	001	0	1	20	08	H5213_001_0	2				1																																																																				
H5213	002	0	1	20	08	H5213_002_0	2				1																																																																				
H5215	002	0	1	04	01	H5215_002_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	005	0	1	04	01	H5215_005_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	007	0	1	04	01	H5215_007_0	5		N		1	1	110110	1		2				2							615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5215	008	0	1	04	01	H5215_008_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	330.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	009	0	1	04	01	H5215_009_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	010	0	1	04	01	H5215_010_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	320.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	011	0	1	04	01	H5215_011_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	012	0	1	04	01	H5215_012_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	330.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																		1		1	1
H5215	013	0	1	04	01	H5215_013_0	4	N	N		2																																																																				
H5215	014	0	1	04	01	H5215_014_0	4	N	N		2																																																																				
H5215	806	0	1	04	01	H5215_806_0	2				1																																																																				
H5215	807	0	1	04	01	H5215_807_0	1	N	N		2																																																																				
H5215	808	0	1	04	01	H5215_808_0	1				1																																																																				
H5216	001	0	1	04	01	H5216_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	006	0	1	04	01	H5216_006_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	011	0	1	04	01	H5216_011_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	013	0	1	04	01	H5216_013_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	014	0	1	04	01	H5216_014_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	017	0	1	04	01	H5216_017_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	019	0	1	04	01	H5216_019_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	023	0	1	04	01	H5216_023_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	027	0	1	04	01	H5216_027_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	032	0	1	04	01	H5216_032_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	034	0	1	04	01	H5216_034_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	037	0	1	04	01	H5216_037_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	039	0	1	04	01	H5216_039_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	042	0	1	04	01	H5216_042_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	043	1	1	04	01	H5216_043_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	043	5	1	04	01	H5216_043_5	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	043	6	1	04	01	H5216_043_6	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	048	0	1	04	01	H5216_048_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	053	0	1	04	01	H5216_053_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	059	0	1	04	01	H5216_059_0	3	N	N		2																																																																				
H5216	062	0	1	04	01	H5216_062_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	063	0	1	04	01	H5216_063_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	064	0	1	04	01	H5216_064_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	068	0	1	04	01	H5216_068_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	070	0	1	04	01	H5216_070_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	072	0	1	04	01	H5216_072_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	073	0	1	04	01	H5216_073_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	074	0	1	04	01	H5216_074_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	078	1	1	04	01	H5216_078_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	078	2	1	04	01	H5216_078_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	078	6	1	04	01	H5216_078_6	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	081	0	1	04	01	H5216_081_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	083	0	1	04	01	H5216_083_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	089	0	1	04	01	H5216_089_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	092	0	1	04	01	H5216_092_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	097	0	1	04	01	H5216_097_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	100	0	1	04	01	H5216_100_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	105	0	1	04	01	H5216_105_0	3	N	N		2																																																																				
H5216	106	0	1	04	01	H5216_106_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	114	0	1	04	01	H5216_114_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	116	0	1	04	01	H5216_116_0	3	N	N		2																																																																				
H5216	120	0	1	04	01	H5216_120_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	124	0	1	04	01	H5216_124_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	128	0	1	04	01	H5216_128_0	4	N	N		2																																																																				
H5216	132	0	1	04	01	H5216_132_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	136	0	1	04	01	H5216_136_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	138	0	1	04	01	H5216_138_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	141	0	1	04	01	H5216_141_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	144	0	1	04	01	H5216_144_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	152	0	1	04	01	H5216_152_0	5	N	N		2																																																																				
H5216	154	0	1	04	01	H5216_154_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	157	0	1	04	01	H5216_157_0	3	N	N		2																																																																				
H5216	160	0	1	04	01	H5216_160_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	161	0	1	04	01	H5216_161_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	164	0	1	04	01	H5216_164_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	168	0	1	04	01	H5216_168_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	173	0	1	04	01	H5216_173_0	3				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	174	0	1	04	01	H5216_174_0	2	N	N		2																																																																				
H5216	175	0	1	04	01	H5216_175_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	179	0	1	04	01	H5216_179_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	180	0	1	04	01	H5216_180_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	188	0	1	04	01	H5216_188_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	190	0	1	04	01	H5216_190_0	3	N	N		2																																																																				
H5216	192	0	1	04	01	H5216_192_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	194	0	1	04	01	H5216_194_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	195	0	1	04	01	H5216_195_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	196	1	1	04	01	H5216_196_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	196	2	1	04	01	H5216_196_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	200	0	1	04	01	H5216_200_0	1	N	N		2																																																																				
H5216	201	0	1	04	01	H5216_201_0	1	N	N		2																																																																				
H5216	203	1	1	04	01	H5216_203_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	203	2	1	04	01	H5216_203_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	205	0	1	04	01	H5216_205_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	206	0	1	04	01	H5216_206_0	3		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	207	0	1	04	01	H5216_207_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	211	0	1	04	01	H5216_211_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	216	0	1	04	01	H5216_216_0	3	N	N		2																																																																				
H5216	217	0	1	04	01	H5216_217_0	2	N	N		2																																																																				
H5216	218	0	1	04	01	H5216_218_0	3	N	N		2																																																																				
H5216	219	0	1	04	01	H5216_219_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	220	0	1	04	01	H5216_220_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	221	0	1	04	01	H5216_221_0	3	N	N		2																																																																				
H5216	223	0	1	04	01	H5216_223_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	224	0	1	04	01	H5216_224_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	225	0	1	04	01	H5216_225_0	3	N	N		2																																																																				
H5216	226	0	1	04	01	H5216_226_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	227	0	1	04	01	H5216_227_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	228	0	1	04	01	H5216_228_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	229	0	1	04	01	H5216_229_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	231	0	1	04	01	H5216_231_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	234	0	1	04	01	H5216_234_0	2	N	N		2																																																																				
H5216	235	0	1	04	01	H5216_235_0	2	N	N		2																																																																				
H5216	236	0	1	04	01	H5216_236_0	2	N	N		2																																																																				
H5216	242	0	1	04	01	H5216_242_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	243	0	1	04	01	H5216_243_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	244	0	1	04	01	H5216_244_0	7			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5216	246	0	1	04	01	H5216_246_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5216	249	0	1	04	01	H5216_249_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	251	0	1	04	01	H5216_251_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	252	0	1	04	01	H5216_252_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	253	0	1	04	01	H5216_253_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	256	0	1	04	01	H5216_256_0	2	N	N		2																																																																				
H5216	257	0	1	04	01	H5216_257_0	4	N	N		2																																																																				
H5216	258	0	1	04	01	H5216_258_0	3	N	N		2																																																																				
H5216	261	0	1	04	01	H5216_261_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	263	0	1	04	01	H5216_263_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	264	0	1	04	01	H5216_264_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	265	0	1	04	01	H5216_265_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	266	0	1	04	01	H5216_266_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	267	0	1	04	01	H5216_267_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	268	0	1	04	01	H5216_268_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	269	0	1	04	01	H5216_269_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	271	0	1	04	01	H5216_271_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	275	0	1	04	01	H5216_275_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	277	0	1	04	01	H5216_277_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	278	1	1	04	01	H5216_278_1	3	N	N		2																																																																				
H5216	278	3	1	04	01	H5216_278_3	2	N	N		2																																																																				
H5216	280	1	1	04	01	H5216_280_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	280	2	1	04	01	H5216_280_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	281	0	1	04	01	H5216_281_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	283	0	1	04	01	H5216_283_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	284	0	1	04	01	H5216_284_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	285	0	1	04	01	H5216_285_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	286	0	1	04	01	H5216_286_0	2	N	N		2																																																																				
H5216	287	0	1	04	01	H5216_287_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	288	0	1	04	01	H5216_288_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	289	0	1	04	01	H5216_289_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	291	0	1	04	01	H5216_291_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	292	0	1	04	01	H5216_292_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	296	0	1	04	01	H5216_296_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	298	0	1	04	01	H5216_298_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	300	0	1	04	01	H5216_300_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	302	0	1	04	01	H5216_302_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	304	0	1	04	01	H5216_304_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	305	0	1	04	01	H5216_305_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	306	0	1	04	01	H5216_306_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	307	0	1	04	01	H5216_307_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	308	0	1	04	01	H5216_308_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	390.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	309	0	1	04	01	H5216_309_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	310	0	1	04	01	H5216_310_0	2	N	N		2																																																																				
H5216	311	0	1	04	01	H5216_311_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	313	0	1	04	01	H5216_313_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	314	0	1	04	01	H5216_314_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	316	1	1	04	01	H5216_316_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	316	3	1	04	01	H5216_316_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	317	0	1	04	01	H5216_317_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	318	1	1	04	01	H5216_318_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	318	2	1	04	01	H5216_318_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	318	3	1	04	01	H5216_318_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	319	0	1	04	01	H5216_319_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	360.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	322	0	1	04	01	H5216_322_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	325	0	1	04	01	H5216_325_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	326	0	1	04	01	H5216_326_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	327	0	1	04	01	H5216_327_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	328	0	1	04	01	H5216_328_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	330	0	1	04	01	H5216_330_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	331	0	1	04	01	H5216_331_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	332	0	1	04	01	H5216_332_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	333	0	1	04	01	H5216_333_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	334	0	1	04	01	H5216_334_0	3			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5216	337	1	1	04	01	H5216_337_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	337	2	1	04	01	H5216_337_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	337	3	1	04	01	H5216_337_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	339	0	1	04	01	H5216_339_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	340	0	1	04	01	H5216_340_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	343	0	1	04	01	H5216_343_0	2	N	N		2																																																																				
H5216	345	0	1	04	01	H5216_345_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	347	0	1	04	01	H5216_347_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	348	0	1	04	01	H5216_348_0	1	N	N		2																																																																				
H5216	350	0	1	04	01	H5216_350_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	351	0	1	04	01	H5216_351_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	352	0	1	04	01	H5216_352_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	353	0	1	04	01	H5216_353_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	355	0	1	04	01	H5216_355_0	3	N	N		2																																																																				
H5216	358	0	1	04	01	H5216_358_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	390.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	359	0	1	04	01	H5216_359_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	360	0	1	04	01	H5216_360_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	361	0	1	04	01	H5216_361_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	362	0	1	04	01	H5216_362_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	363	0	1	04	01	H5216_363_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	366	0	1	04	01	H5216_366_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5216	367	0	1	04	01	H5216_367_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	368	0	1	04	01	H5216_368_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	369	0	1	04	01	H5216_369_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	610.00	1						2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	370	0	1	04	01	H5216_370_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	371	0	1	04	01	H5216_371_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	372	0	1	04	01	H5216_372_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5216	375	0	1	04	01	H5216_375_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5216	376	0	1	04	01	H5216_376_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	377	0	1	04	01	H5216_377_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	379	0	1	04	01	H5216_379_0	2	N	N		2																																																																				
H5216	381	0	1	04	01	H5216_381_0	2	N	N		2																																																																				
H5216	382	0	1	04	01	H5216_382_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	383	0	1	04	01	H5216_383_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	384	0	1	04	01	H5216_384_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	385	0	1	04	01	H5216_385_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	386	1	1	04	01	H5216_386_1	3	N	N		2																																																																				
H5216	386	2	1	04	01	H5216_386_2	2	N	N		2																																																																				
H5216	387	1	1	04	01	H5216_387_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	387	2	1	04	01	H5216_387_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	388	0	1	04	01	H5216_388_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	389	0	1	04	01	H5216_389_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	390	0	1	04	01	H5216_390_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	391	0	1	04	01	H5216_391_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	393	0	1	04	01	H5216_393_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	394	0	1	04	01	H5216_394_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	395	0	1	04	01	H5216_395_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	396	0	1	04	01	H5216_396_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	399	0	1	04	01	H5216_399_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	400	0	1	04	01	H5216_400_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	401	0	1	04	01	H5216_401_0	3				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	402	0	1	04	01	H5216_402_0	3				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	403	0	1	04	01	H5216_403_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	404	0	1	04	01	H5216_404_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	405	0	1	04	01	H5216_405_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	406	0	1	04	01	H5216_406_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	407	0	1	04	01	H5216_407_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	408	0	1	04	01	H5216_408_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	409	0	1	04	01	H5216_409_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	410	0	1	04	01	H5216_410_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	411	0	1	04	01	H5216_411_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	412	0	1	04	01	H5216_412_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	413	0	1	04	01	H5216_413_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	414	0	1	04	01	H5216_414_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5216	416	0	1	04	01	H5216_416_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	417	0	1	04	01	H5216_417_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	420	0	1	04	01	H5216_420_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	421	0	1	04	01	H5216_421_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	423	0	1	04	01	H5216_423_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	424	0	1	04	01	H5216_424_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	425	0	1	04	01	H5216_425_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	426	0	1	04	01	H5216_426_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	427	1	1	04	01	H5216_427_1	5	N	N		2																																																																				
H5216	427	2	1	04	01	H5216_427_2	4	N	N		2																																																																				
H5216	427	3	1	04	01	H5216_427_3	4	N	N		2																																																																				
H5216	427	4	1	04	01	H5216_427_4	3	N	N		2																																																																				
H5216	427	5	1	04	01	H5216_427_5	3	N	N		2																																																																				
H5216	428	1	1	04	01	H5216_428_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	428	2	1	04	01	H5216_428_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	428	3	1	04	01	H5216_428_3	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	428	5	1	04	01	H5216_428_5	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	429	0	1	04	01	H5216_429_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	430	0	1	04	01	H5216_430_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	431	0	1	04	01	H5216_431_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	115.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	432	0	1	04	01	H5216_432_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	433	0	1	04	01	H5216_433_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	435	1	1	04	01	H5216_435_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	435	2	1	04	01	H5216_435_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	435	3	1	04	01	H5216_435_3	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	436	1	1	04	01	H5216_436_1	3	N	N		2																																																																				
H5216	436	2	1	04	01	H5216_436_2	2	N	N		2																																																																				
H5216	436	3	1	04	01	H5216_436_3	3	N	N		2																																																																				
H5216	437	1	1	04	01	H5216_437_1	3	N	N		2																																																																				
H5216	437	2	1	04	01	H5216_437_2	3	N	N		2																																																																				
H5216	441	0	1	04	01	H5216_441_0	2	N	N		2																																																																				
H5216	442	0	1	04	01	H5216_442_0	2	N	N		2																																																																				
H5216	443	0	1	04	01	H5216_443_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	235.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5216	444	0	1	04	01	H5216_444_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	570.00	2	0100000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	446	0	1	04	01	H5216_446_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	447	0	1	04	01	H5216_447_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5216	448	0	1	04	01	H5216_448_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	449	0	1	04	01	H5216_449_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	450	0	1	04	01	H5216_450_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	451	0	1	04	01	H5216_451_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	452	0	1	04	01	H5216_452_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	453	0	1	04	01	H5216_453_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	455	0	1	04	01	H5216_455_0	3	N	N		2																																																																				
H5216	456	1	1	04	01	H5216_456_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	456	2	1	04	01	H5216_456_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	457	1	1	04	01	H5216_457_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	457	2	1	04	01	H5216_457_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	459	0	1	04	01	H5216_459_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	461	0	1	04	01	H5216_461_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	463	0	1	04	01	H5216_463_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	464	0	1	04	01	H5216_464_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	465	0	1	04	01	H5216_465_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5216	466	0	1	04	01	H5216_466_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5216	467	0	1	04	01	H5216_467_0	2	N	N		2																																																																				
H5216	468	0	1	04	01	H5216_468_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5216	469	0	1	04	01	H5216_469_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	470	0	1	04	01	H5216_470_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5216	805	0	1	04	01	H5216_805_0	4				1																																																																				
H5216	806	0	1	04	01	H5216_806_0	3	N	N		2																																																																				
H5216	808	0	2	04	01	H5216_808_0	3				1																																																																				
H5216	809	0	2	04	01	H5216_809_0	3	N	N		2																																																																				
H5216	811	0	1	04	01	H5216_811_0	3				1																																																																				
H5216	812	0	1	04	01	H5216_812_0	3	N	N		2																																																																				
H5216	813	0	1	04	01	H5216_813_0	3				1																																																																				
H5216	814	0	1	04	01	H5216_814_0	3	N	N		2																																																																				
H5216	817	0	1	04	01	H5216_817_0	3				1																																																																				
H5216	818	0	1	04	01	H5216_818_0	3	N	N		2																																																																				
H5216	821	0	1	04	01	H5216_821_0	3				1																																																																				
H5216	824	0	1	04	01	H5216_824_0	3	N	N		2																																																																				
H5232	001	0	1	04	01	H5232_001_0	18			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0111110	1																																		1		1	1
H5244	001	0	1	01	01	H5244_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H5244	002	0	1	01	01	H5244_002_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H5244	004	0	1	01	01	H5244_004_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H5244	005	0	1	01	01	H5244_005_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H5244	801	0	1	01	01	H5244_801_0	5				1																																																																				
H5244	802	0	1	01	01	H5244_802_0	5				1																																																																				
H5244	803	0	1	01	01	H5244_803_0	5	N	N		2																																																																				
H5244	804	0	1	01	01	H5244_804_0	5	N	N		2																																																																				
H5253	004	0	1	02	01	H5253_004_0	8			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	007	0	1	02	01	H5253_007_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5253	011	0	1	02	01	H5253_011_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	021	0	1	02	01	H5253_021_0	7	N	N		2																																																																				
H5253	024	0	1	02	01	H5253_024_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5253	030	0	1	02	01	H5253_030_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	033	0	1	02	01	H5253_033_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	034	0	1	02	01	H5253_034_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	035	0	1	02	01	H5253_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	036	0	1	02	01	H5253_036_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	037	0	1	02	01	H5253_037_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	038	0	1	02	01	H5253_038_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	039	0	1	02	01	H5253_039_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	040	0	1	02	01	H5253_040_0	3	N	N		2																																																																				
H5253	041	0	1	02	01	H5253_041_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5253	047	0	1	02	01	H5253_047_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	048	0	1	02	01	H5253_048_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	051	0	1	02	01	H5253_051_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	059	0	1	01	01	H5253_059_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H5253	062	0	1	02	01	H5253_062_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	064	0	1	02	01	H5253_064_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	072	0	1	02	01	H5253_072_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	079	0	1	02	01	H5253_079_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	080	0	1	02	01	H5253_080_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	081	0	1	02	01	H5253_081_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	082	0	1	02	01	H5253_082_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	084	0	1	02	01	H5253_084_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	087	0	1	02	01	H5253_087_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	088	0	1	02	01	H5253_088_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	089	0	1	02	01	H5253_089_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	097	0	1	02	01	H5253_097_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	099	0	1	02	01	H5253_099_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	100	0	1	02	01	H5253_100_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	103	0	1	02	01	H5253_103_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	104	0	1	02	01	H5253_104_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	105	0	1	02	01	H5253_105_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	108	1	1	02	01	H5253_108_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	108	2	1	02	01	H5253_108_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	108	3	1	02	01	H5253_108_3	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	109	1	1	02	01	H5253_109_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	109	2	1	02	01	H5253_109_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	109	4	1	02	01	H5253_109_4	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	110	0	1	02	01	H5253_110_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	111	1	1	02	01	H5253_111_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	111	2	1	02	01	H5253_111_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	112	1	1	02	01	H5253_112_1	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	112	2	1	02	01	H5253_112_2	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	113	0	1	02	01	H5253_113_0	3	N	N		2																																																																				
H5253	116	0	1	02	01	H5253_116_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5253	117	0	1	02	01	H5253_117_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	119	0	1	02	01	H5253_119_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	120	0	1	02	01	H5253_120_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	121	0	1	02	01	H5253_121_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	122	0	1	01	01	H5253_122_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H5253	124	1	1	02	01	H5253_124_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	124	2	1	02	01	H5253_124_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	125	1	1	02	01	H5253_125_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	125	2	1	02	01	H5253_125_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	126	1	1	02	01	H5253_126_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	126	2	1	02	01	H5253_126_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	127	0	1	02	01	H5253_127_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	128	0	1	02	01	H5253_128_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	130	0	1	02	01	H5253_130_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	131	0	1	02	01	H5253_131_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	132	0	1	02	01	H5253_132_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	133	0	1	02	01	H5253_133_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	134	0	1	02	01	H5253_134_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	135	0	1	02	01	H5253_135_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	141	0	1	02	01	H5253_141_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	142	0	1	02	01	H5253_142_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	143	0	1	02	01	H5253_143_0	3	N	N		2																																																																				
H5253	144	1	1	02	01	H5253_144_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	144	2	1	02	01	H5253_144_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	145	0	1	02	01	H5253_145_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	146	0	1	02	01	H5253_146_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	147	0	1	02	01	H5253_147_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	148	0	1	02	01	H5253_148_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	149	0	1	02	01	H5253_149_0	3	N	N		2																																																																				
H5253	150	0	1	02	01	H5253_150_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	152	0	1	02	01	H5253_152_0	3	N	N		2																																																																				
H5253	154	0	1	02	01	H5253_154_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	155	0	1	02	01	H5253_155_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	157	1	1	02	01	H5253_157_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	157	2	1	02	01	H5253_157_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	159	0	1	02	01	H5253_159_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	161	0	1	02	01	H5253_161_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	162	1	1	02	01	H5253_162_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	162	2	1	02	01	H5253_162_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	166	0	1	02	01	H5253_166_0	6				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5253	168	0	1	02	01	H5253_168_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	169	0	1	02	01	H5253_169_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	171	0	1	02	01	H5253_171_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	172	0	1	02	01	H5253_172_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	173	0	1	02	01	H5253_173_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	174	0	1	02	01	H5253_174_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	175	0	1	02	01	H5253_175_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	176	0	1	02	01	H5253_176_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	178	0	1	02	01	H5253_178_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	179	0	1	02	01	H5253_179_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	180	0	1	02	01	H5253_180_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	182	0	1	02	01	H5253_182_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	183	0	1	02	01	H5253_183_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	184	0	1	02	01	H5253_184_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5253	185	0	1	02	01	H5253_185_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	186	0	1	02	01	H5253_186_0	11			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	187	0	1	02	01	H5253_187_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	188	0	1	02	01	H5253_188_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	189	0	1	02	01	H5253_189_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	190	0	1	02	01	H5253_190_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	192	0	1	02	01	H5253_192_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	193	1	1	02	01	H5253_193_1	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	193	2	1	02	01	H5253_193_2	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	194	1	1	02	01	H5253_194_1	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5253	194	2	1	02	01	H5253_194_2	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5253	195	0	1	02	01	H5253_195_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	196	0	1	02	01	H5253_196_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	197	0	1	02	01	H5253_197_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	198	0	1	02	01	H5253_198_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	199	0	1	02	01	H5253_199_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	200	0	1	02	01	H5253_200_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5253	201	0	1	02	01	H5253_201_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	202	0	1	02	01	H5253_202_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	203	0	1	02	01	H5253_203_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	204	0	1	02	01	H5253_204_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	205	0	1	02	01	H5253_205_0	3	N	N		2																																																																				
H5253	206	0	1	02	01	H5253_206_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	207	0	1	02	01	H5253_207_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	208	0	1	02	01	H5253_208_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	209	0	1	02	01	H5253_209_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5253	801	0	1	01	01	H5253_801_0	1				1																																																																				
H5253	802	0	1	01	01	H5253_802_0	1	N	N		2																																																																				
H5253	805	0	1	01	01	H5253_805_0	1				1																																																																				
H5253	810	0	1	01	01	H5253_810_0	1				1																																																																				
H5253	811	0	1	01	01	H5253_811_0	1				1																																																																				
H5253	812	0	1	01	01	H5253_812_0	1	N	N		2																																																																				
H5253	813	0	1	01	01	H5253_813_0	1				1																																																																				
H5253	814	0	1	01	01	H5253_814_0	1				1																																																																				
H5253	815	0	1	01	01	H5253_815_0	1	N	N		2																																																																				
H5253	816	0	2	01	01	H5253_816_0	1				1																																																																				
H5253	817	0	2	01	01	H5253_817_0	1				1																																																																				
H5253	818	0	1	01	01	H5253_818_0	1				1																																																																				
H5253	819	0	1	01	01	H5253_819_0	1	N	N		2																																																																				
H5253	820	0	1	01	01	H5253_820_0	1				1																																																																				
H5253	821	0	1	01	01	H5253_821_0	1				1																																																																				
H5253	822	0	1	01	01	H5253_822_0	1	N	N		2																																																																				
H5253	823	0	1	01	01	H5253_823_0	1				1																																																																				
H5253	824	0	1	01	01	H5253_824_0	1				1																																																																				
H5253	825	0	1	01	01	H5253_825_0	1	N	N		2																																																																				
H5253	826	0	2	01	01	H5253_826_0	1				1																																																																				
H5253	827	0	1	01	01	H5253_827_0	1				1																																																																				
H5253	828	0	1	01	01	H5253_828_0	1	N	N		2																																																																				
H5253	829	0	1	01	01	H5253_829_0	1				1																																																																				
H5253	830	0	1	01	01	H5253_830_0	1	N	N		2																																																																				
H5253	831	0	1	01	01	H5253_831_0	1				1																																																																				
H5253	832	0	1	01	01	H5253_832_0	1				1																																																																				
H5256	001	0	1	18	06	H5256_001_0	1	N	N		2																																																																				
H5256	002	0	1	18	06	H5256_002_0	1	N	N		2																																																																				
H5256	004	0	1	18	06	H5256_004_0	2	N	N		2																																																																				
H5256	005	0	1	18	06	H5256_005_0	1	N	N		2																																																																				
H5262	001	0	1	01	01	H5262_001_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	•Plan includes a deductible of $200 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	003	0	1	01	01	H5262_003_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0110001	1				2	1	111	•Plan includes a deductible of $225 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	004	0	1	01	01	H5262_004_0	3	N	N		2																																																																				
H5262	005	0	1	01	01	H5262_005_0	3	N	N		2																																																																				
H5262	007	0	1	01	01	H5262_007_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	•Plan includes a deductible of $200 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $5 and $15 respectively.	2	3		0001100	1																																		1		1	1
H5262	008	0	1	01	01	H5262_008_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0110001	1				2	1	111	•Plan includes a deductible of $225 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $5 and $15 respectively.	2	3		0001100	1																																		1		1	1
H5262	009	0	1	01	01	H5262_009_0	3	N	N		2																																																																				
H5262	010	0	1	01	01	H5262_010_0	3	N	N		2																																																																				
H5262	021	0	1	01	01	H5262_021_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	023	0	1	01	01	H5262_023_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	029	0	1	01	01	H5262_029_0	5		N	5F4	1	2	110110	1		2		6	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1		615.00														0001100																																			1	1	1	1
H5262	030	0	1	01	01	H5262_030_0	5		N	5F4	1	2	110110	1		2		6	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1		615.00														0001100																																			1	1	1	1
H5262	032	0	1	01	01	H5262_032_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	033	0	1	01	01	H5262_033_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H5262	801	0	1	01	01	H5262_801_0	3				1																																																																				
H5262	802	0	1	01	01	H5262_802_0	3	N	N		2																																																																				
H5264	002	0	1	18	06	H5264_002_0	2	N	N		2																																																																				
H5264	005	0	1	18	06	H5264_005_0	2	N	N		2																																																																				
H5272	001	0	1	01	01	H5272_001_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	480.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5273	001	0	1	01	01	H5273_001_0	7			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	450.00	2	0110001	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H5273	801	0	1	01	01	H5273_801_0	3				1																																																																				
H5273	802	0	1	01	01	H5273_802_0	3				1																																																																				
H5273	803	0	1	01	01	H5273_803_0	3	N	N		2																																																																				
H5273	804	0	1	01	01	H5273_804_0	3	N	N		2																																																																				
H5294	010	0	1	01	01	H5294_010_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5294	011	0	1	01	01	H5294_011_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5294	013	0	1	01	01	H5294_013_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H5294	014	0	1	01	01	H5294_014_0	8	N	N		2																																																																				
H5294	015	0	1	01	01	H5294_015_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5294	016	0	1	01	01	H5294_016_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	600.00	2	0000001	1				2					3		0001100	1																																		1		1	1
H5294	017	0	1	01	01	H5294_017_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5294	018	0	1	01	01	H5294_018_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5294	019	0	1	01	01	H5294_019_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5294	021	0	1	01	01	H5294_021_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	490.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5294	022	0	1	01	01	H5294_022_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5294	023	0	1	01	01	H5294_023_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5294	024	0	1	01	01	H5294_024_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H5294	025	0	1	01	01	H5294_025_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	590.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H5296	003	0	1	01	01	H5296_003_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H5296	004	0	1	02	01	H5296_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1	1	1	1
H5296	006	0	1	01	01	H5296_006_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H5296	007	0	1	01	01	H5296_007_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H5296	008	0	1	01	01	H5296_008_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H5296	009	0	1	02	01	H5296_009_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H5296	010	0	1	01	01	H5296_010_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0110001	1				2	1	111	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit for select tiers.	1	3		0111100	3																																		1		1	1
H5296	011	0	1	01	01	H5296_011_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit for select tiers.	1	3		0111100	3																																		1		1	1
H5296	801	0	1	01	01	H5296_801_0	1				1																																																																				
H5296	802	0	1	01	01	H5296_802_0	1				1																																																																				
H5296	803	0	1	01	01	H5296_803_0	1	N	N		2																																																																				
H5296	804	0	1	01	01	H5296_804_0	1	N	N		2																																																																				
H5299	001	0	1	01	01	H5299_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5299	002	0	1	01	01	H5299_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5299	006	0	1	01	01	H5299_006_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H5299	009	0	1	01	01	H5299_009_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H5299	012	0	1	01	01	H5299_012_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5299	013	0	1	01	01	H5299_013_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H5299	014	0	1	01	01	H5299_014_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5299	015	0	1	01	01	H5299_015_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5299	016	0	1	01	01	H5299_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5299	017	0	1	01	01	H5299_017_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5299	018	0	1	01	01	H5299_018_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5302	012	0	1	01	01	H5302_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5302	020	0	1	01	01	H5302_020_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5302	022	0	1	01	01	H5302_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5302	023	0	1	01	01	H5302_023_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5302	024	0	1	01	01	H5302_024_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5302	026	0	1	01	01	H5302_026_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5302	809	0	1	01	01	H5302_809_0	1	N	N		2																																																																				
H5314	001	0	1	01	01	H5314_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5314	002	0	1	01	01	H5314_002_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5322	025	0	1	02	01	H5322_025_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	464.00	2	0100000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H5322	026	0	1	02	01	H5322_026_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	502.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H5322	028	0	1	02	01	H5322_028_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H5322	029	0	1	02	01	H5322_029_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	031	0	1	02	01	H5322_031_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	033	0	1	02	01	H5322_033_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	034	0	1	02	01	H5322_034_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1	1	1	1
H5322	038	0	1	02	01	H5322_038_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	040	0	1	02	01	H5322_040_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5322	043	0	1	02	01	H5322_043_0	3	N	N		2																																																																				
H5322	044	0	1	02	01	H5322_044_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5322	046	0	1	02	01	H5322_046_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	047	1	1	02	01	H5322_047_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5322	047	2	1	02	01	H5322_047_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5322	049	1	1	02	01	H5322_049_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	049	2	1	02	01	H5322_049_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	050	1	1	02	01	H5322_050_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	050	2	1	02	01	H5322_050_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5322	801	0	1	01	01	H5322_801_0	1				1																																																																				
H5322	802	0	1	01	01	H5322_802_0	1	N	N		2																																																																				
H5322	803	0	1	01	01	H5322_803_0	1				1																																																																				
H5322	804	0	2	01	01	H5322_804_0	1				1																																																																				
H5325	003	0	1	01	01	H5325_003_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	004	0	1	01	01	H5325_004_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	005	0	1	01	01	H5325_005_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	006	0	1	01	01	H5325_006_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	007	0	1	01	01	H5325_007_0	3		N	5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	011	0	1	01	01	H5325_011_0	2		N	5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	012	0	1	01	01	H5325_012_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	013	0	1	01	01	H5325_013_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	014	0	1	01	01	H5325_014_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5325	015	0	1	01	01	H5325_015_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5361	001	0	1	04	01	H5361_001_0	9			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan offers a $0 deductible and $0 copays for Tiers 1 and 2 at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H5361	002	0	1	04	01	H5361_002_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	The plan features a reduced deductible, with Tier 1 and Tier 2 drugs excluded from the deductible and covered with a $0 copay at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H5361	004	0	1	04	01	H5361_004_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	125.00	2	0110000	1				1	1	111	The plan features a reduced deductible, with Tier 1 and Tier 2 drugs excluded from the deductible and covered with a $0 copay at preferred pharmacies.	2	3		0001110	1																																		1		1	1
H5374	001	0	1	01	01	H5374_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H5377	002	0	1	02	01	H5377_002_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5377	003	0	1	01	01	H5377_003_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5386	003	0	1	01	01	H5386_003_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0111001	1				1	1	111	Enhancements to the defined standard benefit include a reduced deductible of $0 and reduced cost copays (e.g. Tier 1 and Tier 2 copays). The changes were determined to be richer than the defined standard benefits by comparing outputs from the 2026 OOPC model.	2	3		0001110	1																																				1	1
H5386	004	0	1	01	01	H5386_004_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0111001	1				1	1	111	Enhancements to the defined standard benefit include a reduced deductible of $0 and reduced cost copays (e.g. Tier 1 and Tier 2 copays). The changes were determined to be richer than the defined standard benefits by comparing outputs from the 2026 OOPC model.	2	3		0001110	1																																				1	1
H5386	005	0	1	01	01	H5386_005_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0111001	1				1	1	111	Enhancements to the defined standard benefit include a reduced deductible of $0 and reduced cost copays (e.g. Tier 1 and Tier 2 copays). The changes were determined to be richer than the defined standard benefits by comparing outputs from the 2026 OOPC model.	2	3		0001110	1																																				1	1
H5386	006	0	1	01	01	H5386_006_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0111001	1				1	1	111	Enhancements to the defined standard benefit include a reduced deductible of $0 and reduced cost copays (e.g. Tier 1 and Tier 2 copays). The changes were determined to be richer than the defined standard benefits by comparing outputs from the 2026 OOPC model.	2	3		0001110	1																																				1	1
H5386	801	0	1	01	01	H5386_801_0	4				1																																																																				
H5386	802	0	1	01	01	H5386_802_0	4				1																																																																				
H5386	803	0	1	01	01	H5386_803_0	4	N	N		2																																																																				
H5397	001	0	1	01	01	H5397_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5397	002	0	1	01	01	H5397_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5397	003	0	1	01	01	H5397_003_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5397	004	0	1	01	01	H5397_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5397	005	0	1	01	01	H5397_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5403	001	0	1	20	08	H5403_001_0	2				1																																																																				
H5403	002	0	1	20	08	H5403_002_0	2				1																																																																				
H5405	001	0	1	20	08	H5405_001_0	4				1																																																																				
H5405	002	0	1	20	08	H5405_002_0	4				1																																																																				
H5406	001	0	1	20	08	H5406_001_0	2				1																																																																				
H5406	002	0	1	20	08	H5406_002_0	2				1																																																																				
H5410	004	0	1	01	01	H5410_004_0	3	N	N		2																																																																				
H5410	013	0	1	01	01	H5410_013_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	018	0	1	01	01	H5410_018_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H5410	024	0	1	01	01	H5410_024_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H5410	025	0	1	01	01	H5410_025_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	026	0	1	01	01	H5410_026_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H5410	031	0	1	01	01	H5410_031_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	032	0	1	01	01	H5410_032_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	042	0	1	01	01	H5410_042_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	045	0	1	01	01	H5410_045_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	046	0	1	01	01	H5410_046_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	047	0	1	01	01	H5410_047_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	055	0	1	01	01	H5410_055_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	056	0	1	01	01	H5410_056_0	5		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H5410	059	0	1	01	01	H5410_059_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H5410	060	0	1	01	01	H5410_060_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H5410	808	0	1	01	01	H5410_808_0	2				1																																																																				
H5420	001	0	1	01	01	H5420_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Members have no deductible, Members pay copays instead of coinsurance on tiers 1, 2, and 3, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5420	003	0	1	01	01	H5420_003_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5420	006	0	1	01	01	H5420_006_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5420	014	0	1	01	01	H5420_014_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Members have no deductible, Members pay copays instead of coinsurance on tiers 1, 2, and 3, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5420	015	0	1	01	01	H5420_015_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5420	016	0	1	02	01	H5420_016_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H5422	011	0	1	02	01	H5422_011_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5422	013	0	1	02	01	H5422_013_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	390.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1		1	1
H5422	014	0	1	02	01	H5422_014_0	4	N	N		2																																																																				
H5422	015	0	1	02	01	H5422_015_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H5422	018	0	1	01	01	H5422_018_0	4		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	355.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5422	019	0	1	01	01	H5422_019_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	520.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5422	803	0	1	01	01	H5422_803_0	1	N	N		2																																																																				
H5422	804	0	1	01	01	H5422_804_0	1				1																																																																				
H5422	806	0	2	01	01	H5422_806_0	1				1																																																																				
H5422	807	0	2	01	01	H5422_807_0	1	N	N		2																																																																				
H5422	809	0	1	01	01	H5422_809_0	1	N	N		2																																																																				
H5422	811	0	2	01	01	H5422_811_0	1	N	N		2																																																																				
H5425	001	0	1	01	01	H5425_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	005	0	1	01	01	H5425_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	006	0	1	01	01	H5425_006_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	007	0	1	01	01	H5425_007_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	008	0	1	01	01	H5425_008_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	009	0	1	01	01	H5425_009_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	019	0	1	01	01	H5425_019_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	034	0	1	01	01	H5425_034_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	065	0	1	01	01	H5425_065_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	069	0	1	01	01	H5425_069_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	070	0	1	01	01	H5425_070_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	075	0	1	01	01	H5425_075_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	076	0	1	01	01	H5425_076_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	082	0	1	01	01	H5425_082_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	084	0	1	01	01	H5425_084_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	085	0	1	01	01	H5425_085_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	086	0	1	01	01	H5425_086_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H5425	087	0	1	01	01	H5425_087_0	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H5425	091	0	1	02	01	H5425_091_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H5425	092	0	1	01	01	H5425_092_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	096	0	1	01	01	H5425_096_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	097	0	1	01	01	H5425_097_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H5425	098	0	1	01	01	H5425_098_0	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	100	0	1	01	01	H5425_100_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	101	0	1	01	01	H5425_101_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	102	0	1	01	01	H5425_102_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	104	0	1	01	01	H5425_104_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	105	0	1	01	01	H5425_105_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	106	0	1	01	01	H5425_106_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	107	0	1	01	01	H5425_107_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	108	0	1	01	01	H5425_108_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	109	0	1	01	01	H5425_109_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	110	0	1	01	01	H5425_110_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	118	0	1	01	01	H5425_118_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	119	0	1	01	01	H5425_119_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	120	0	1	01	01	H5425_120_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	121	0	1	01	01	H5425_121_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	123	0	1	01	01	H5425_123_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	124	0	1	01	01	H5425_124_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	125	0	1	01	01	H5425_125_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	126	0	1	01	01	H5425_126_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	127	0	1	01	01	H5425_127_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	128	0	1	01	01	H5425_128_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	129	0	1	01	01	H5425_129_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5425	130	0	1	01	01	H5425_130_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	131	0	1	01	01	H5425_131_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H5425	132	0	1	02	01	H5425_132_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H5425	133	0	1	01	01	H5425_133_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	134	0	1	01	01	H5425_134_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	135	0	1	01	01	H5425_135_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	1	3		0001100	1																																		1		1	1
H5425	803	0	1	01	01	H5425_803_0	5				1																																																																				
H5425	804	0	1	01	01	H5425_804_0	5				1																																																																				
H5425	806	0	1	01	01	H5425_806_0	5	N	N		2																																																																				
H5425	807	0	1	01	01	H5425_807_0	5	N	N		2																																																																				
H5427	052	0	1	01	01	H5427_052_0	4	N	N		2																																																																				
H5427	059	0	1	01	01	H5427_059_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	060	0	1	01	01	H5427_060_0	6			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	070	0	1	01	01	H5427_070_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5427	072	0	1	01	01	H5427_072_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5427	077	0	1	01	01	H5427_077_0	6			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	078	0	1	01	01	H5427_078_0	7		N	4E1	1	4	110110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100010	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0111000	1																																		1	1	1	1
H5427	082	0	1	01	01	H5427_082_0	5			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5427	083	0	1	01	01	H5427_083_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	087	0	1	01	01	H5427_087_0	7		N	4E1	1	4	110110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100010	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0111000	1																																		1	1	1	1
H5427	088	0	1	01	01	H5427_088_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	089	0	1	01	01	H5427_089_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	091	0	1	01	01	H5427_091_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	093	0	1	01	01	H5427_093_0	4			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	094	0	1	01	01	H5427_094_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	096	0	1	01	01	H5427_096_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	099	0	1	01	01	H5427_099_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5427	102	0	1	01	01	H5427_102_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	103	0	1	01	01	H5427_103_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	105	0	1	01	01	H5427_105_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	106	0	1	01	01	H5427_106_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	107	0	1	01	01	H5427_107_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	108	0	1	01	01	H5427_108_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5427	112	0	1	02	01	H5427_112_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5427	113	0	1	02	01	H5427_113_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5431	001	0	1	01	01	H5431_001_0	4			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	006	0	1	01	01	H5431_006_0	5			5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	012	0	1	01	01	H5431_012_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	013	0	1	01	01	H5431_013_0	4			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	016	0	1	01	01	H5431_016_0	6		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																			1	1	1
H5431	017	0	1	01	01	H5431_017_0	4			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	018	0	1	01	01	H5431_018_0	4			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	019	0	1	01	01	H5431_019_0	6		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																			1	1	1
H5431	020	0	1	01	01	H5431_020_0	4			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	021	0	1	01	01	H5431_021_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	022	0	1	01	01	H5431_022_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5431	025	0	1	01	01	H5431_025_0	6		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																			1	1	1
H5431	026	0	1	01	01	H5431_026_0	6		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																			1	1	1
H5433	001	0	1	01	01	H5433_001_0	4		N	2A	1	4	110110	1	2	2		2	2	1	1			Generic, Brand		1	615.00	2	0100000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for formulary tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0110000	1																																		1	1	1	1
H5434	002	0	1	04	01	H5434_002_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	023	0	1	04	01	H5434_023_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	024	0	1	04	01	H5434_024_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	025	0	1	04	01	H5434_025_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	026	0	1	04	01	H5434_026_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	030	0	1	04	01	H5434_030_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	031	0	1	04	01	H5434_031_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	034	0	1	04	01	H5434_034_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	035	0	1	04	01	H5434_035_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	036	0	1	04	01	H5434_036_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	038	0	1	04	01	H5434_038_0	5	N	N		2																																																																				
H5434	040	0	1	04	01	H5434_040_0	5	N	N		2																																																																				
H5434	041	0	1	04	01	H5434_041_0	5	N	N		2																																																																				
H5434	042	0	1	04	01	H5434_042_0	5	N	N		2																																																																				
H5434	044	0	1	04	01	H5434_044_0	5	N	N		2																																																																				
H5434	045	0	1	04	01	H5434_045_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
H5434	046	0	1	04	01	H5434_046_0	4	N	N		2																																																																				
H5434	801	0	1	04	01	H5434_801_0	2				1																																																																				
H5434	802	0	1	04	01	H5434_802_0	2				1																																																																				
H5434	806	0	1	04	01	H5434_806_0	2	N	N		2																																																																				
H5434	807	0	1	04	01	H5434_807_0	2	N	N		2																																																																				
H5435	001	0	1	09	04	H5435_001_0	3	N	N		2																																																																				
H5435	024	0	1	09	04	H5435_024_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5439	010	0	1	04	01	H5439_010_0	9	N	N		2																																																																				
H5439	011	0	1	04	01	H5439_011_0	12			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5439	015	0	1	04	01	H5439_015_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5439	019	0	1	04	01	H5439_019_0	10			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5439	022	1	1	04	01	H5439_022_1	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5439	022	2	1	04	01	H5439_022_2	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5439	022	3	1	04	01	H5439_022_3	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5447	001	0	1	01	01	H5447_001_0	6			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	Cost sharing has been reduced, which increases the plan paid amount per drug for these classes, therefore increasing the actuarial value.	2	3		0011100	1																																		1		1	1
H5447	002	0	1	01	01	H5447_002_0	6		N	5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	Cost sharing has been reduced, which increases the plan paid amount per drug for these classes, therefore increasing the actuarial value.	2	3		0011100	1																																		1	1	1	1
H5453	001	0	1	04	01	H5453_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	002	0	1	04	01	H5453_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	003	0	1	04	01	H5453_003_0	4	N	N		2																																																																				
H5453	004	0	1	04	01	H5453_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	005	0	1	04	01	H5453_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	010	0	1	04	01	H5453_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	460.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	011	0	1	04	01	H5453_011_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5453	015	0	1	04	01	H5453_015_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5453	016	0	1	04	01	H5453_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5453	017	0	1	04	01	H5453_017_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5453	018	0	1	04	01	H5453_018_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5454	001	0	1	01	01	H5454_001_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H5454	002	0	1	01	01	H5454_002_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H5454	005	0	1	01	01	H5454_005_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H5454	006	0	1	01	01	H5454_006_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H5471	064	0	1	01	01	H5471_064_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	065	0	1	01	01	H5471_065_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	066	0	1	01	01	H5471_066_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	069	0	1	01	01	H5471_069_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	070	0	1	01	01	H5471_070_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	071	0	1	01	01	H5471_071_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	072	0	1	01	01	H5471_072_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	073	0	1	01	01	H5471_073_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	074	0	1	01	01	H5471_074_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	075	0	1	01	01	H5471_075_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	076	0	1	01	01	H5471_076_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	077	0	1	01	01	H5471_077_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	078	0	1	01	01	H5471_078_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	080	0	1	01	01	H5471_080_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	082	0	1	01	01	H5471_082_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	084	0	1	01	01	H5471_084_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	110	0	1	01	01	H5471_110_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	111	0	1	01	01	H5471_111_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	112	0	1	01	01	H5471_112_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	113	0	1	01	01	H5471_113_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	114	0	1	01	01	H5471_114_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	115	0	1	01	01	H5471_115_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	116	0	1	01	01	H5471_116_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	117	0	1	01	01	H5471_117_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	118	0	1	01	01	H5471_118_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	119	0	1	01	01	H5471_119_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	120	0	1	01	01	H5471_120_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	121	0	1	01	01	H5471_121_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	122	0	1	01	01	H5471_122_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	123	0	1	01	01	H5471_123_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	124	0	1	01	01	H5471_124_0	5			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	125	0	1	01	01	H5471_125_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	126	0	1	01	01	H5471_126_0	6			5F1	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0001100	1																																				1	1
H5471	127	0	1	01	01	H5471_127_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	128	0	1	01	01	H5471_128_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	129	0	1	01	01	H5471_129_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	130	0	1	01	01	H5471_130_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	131	0	1	01	01	H5471_131_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	132	0	1	01	01	H5471_132_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	133	0	1	01	01	H5471_133_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	134	0	1	01	01	H5471_134_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	135	0	1	01	01	H5471_135_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	136	0	1	01	01	H5471_136_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	137	0	1	01	01	H5471_137_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	138	0	1	01	01	H5471_138_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		2	490.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	139	0	1	01	01	H5471_139_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	140	0	1	01	01	H5471_140_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	141	0	1	01	01	H5471_141_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	142	0	1	01	01	H5471_142_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5471	143	0	1	01	01	H5471_143_0	7		N	5F1	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0001100	1																																		1	1	1	1
H5472	001	0	1	02	01	H5472_001_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H5472	002	0	1	02	01	H5472_002_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H5472	003	0	1	02	01	H5472_003_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H5472	004	0	1	02	01	H5472_004_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H5472	007	0	1	02	01	H5472_007_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1	1	1	1
H5472	009	0	1	02	01	H5472_009_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1	1	1	1
H5472	010	0	1	02	01	H5472_010_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H5472	801	0	1	01	01	H5472_801_0	1				1																																																																				
H5472	802	0	1	01	01	H5472_802_0	1				1																																																																				
H5472	803	0	1	01	01	H5472_803_0	1	N	N		2																																																																				
H5472	804	0	1	01	01	H5472_804_0	1	N	N		2																																																																				
H5475	001	0	1	02	01	H5475_001_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5475	026	0	1	02	01	H5475_026_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5475	031	0	1	02	01	H5475_031_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5475	038	0	1	02	01	H5475_038_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	580.00	2	0000001	1				2					3		0001100	1																																		1		1	1
H5475	039	0	1	02	01	H5475_039_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H5493	001	0	1	20	08	H5493_001_0	2				1																																																																				
H5493	002	0	1	20	08	H5493_002_0	2				1																																																																				
H5496	005	0	1	01	01	H5496_005_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1, 2, 3, 4 and 6 in the coverage phase.	1	3		0011100	1																																				1	1
H5496	012	0	1	01	01	H5496_012_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1, 2, 3, and 4 in the coverage phase.	1	3		0011100	1																																				1	1
H5496	016	0	1	01	01	H5496_016_0	4	N	N		2																																																																				
H5521	015	0	1	04	01	H5521_015_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	016	0	1	04	01	H5521_016_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	020	0	1	04	01	H5521_020_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	022	0	1	04	01	H5521_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	033	0	1	04	01	H5521_033_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	037	0	1	04	01	H5521_037_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	055	0	1	04	01	H5521_055_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	077	0	1	04	01	H5521_077_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	081	0	1	04	01	H5521_081_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	084	0	1	04	01	H5521_084_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	085	0	1	04	01	H5521_085_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	086	0	1	04	01	H5521_086_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	087	0	1	04	01	H5521_087_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	088	0	1	04	01	H5521_088_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	089	0	1	04	01	H5521_089_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	091	0	1	04	01	H5521_091_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	095	0	1	04	01	H5521_095_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	099	0	1	04	01	H5521_099_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	116	0	1	04	01	H5521_116_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	119	0	1	04	01	H5521_119_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	120	0	1	04	01	H5521_120_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	121	0	1	04	01	H5521_121_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	122	0	1	04	01	H5521_122_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	123	0	1	04	01	H5521_123_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	124	0	1	04	01	H5521_124_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	139	0	1	04	01	H5521_139_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	140	0	1	04	01	H5521_140_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	141	0	1	04	01	H5521_141_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	150	0	1	04	01	H5521_150_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	156	0	1	04	01	H5521_156_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	157	0	1	04	01	H5521_157_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	159	0	1	04	01	H5521_159_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	160	0	1	04	01	H5521_160_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	169	0	1	04	01	H5521_169_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	170	0	1	04	01	H5521_170_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	171	0	1	04	01	H5521_171_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	194	0	1	04	01	H5521_194_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	195	0	1	04	01	H5521_195_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	207	0	1	04	01	H5521_207_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	211	0	1	04	01	H5521_211_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	214	0	1	04	01	H5521_214_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	215	0	1	04	01	H5521_215_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	218	0	1	04	01	H5521_218_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	219	0	1	04	01	H5521_219_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	223	0	1	04	01	H5521_223_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	224	0	1	04	01	H5521_224_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	227	0	1	04	01	H5521_227_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	229	0	1	04	01	H5521_229_0	2	N	N		2																																																																				
H5521	231	0	1	04	01	H5521_231_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	233	0	1	04	01	H5521_233_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	235	0	1	04	01	H5521_235_0	2	N	N		2																																																																				
H5521	236	0	1	04	01	H5521_236_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	241	0	1	04	01	H5521_241_0	2	N	N		2																																																																				
H5521	243	0	1	04	01	H5521_243_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	245	0	1	04	01	H5521_245_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	246	0	1	04	01	H5521_246_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	249	0	1	04	01	H5521_249_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	250	0	1	04	01	H5521_250_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	251	0	1	04	01	H5521_251_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	254	0	1	04	01	H5521_254_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	260	0	1	04	01	H5521_260_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	261	0	1	04	01	H5521_261_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	263	0	1	04	01	H5521_263_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	269	0	1	04	01	H5521_269_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	270	0	1	04	01	H5521_270_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	271	0	1	04	01	H5521_271_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	272	0	1	04	01	H5521_272_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	273	0	1	04	01	H5521_273_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	275	0	1	04	01	H5521_275_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	277	0	1	04	01	H5521_277_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	279	0	1	04	01	H5521_279_0	2	N	N		2																																																																				
H5521	285	0	1	04	01	H5521_285_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	286	0	1	04	01	H5521_286_0	2	N	N		2																																																																				
H5521	289	0	1	04	01	H5521_289_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	292	0	1	04	01	H5521_292_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	296	0	1	04	01	H5521_296_0	2	N	N		2																																																																				
H5521	299	0	1	04	01	H5521_299_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	302	0	1	04	01	H5521_302_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	303	0	1	04	01	H5521_303_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	305	0	1	04	01	H5521_305_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	306	0	1	04	01	H5521_306_0	2	N	N		2																																																																				
H5521	314	0	1	04	01	H5521_314_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	319	0	1	04	01	H5521_319_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	320	0	1	04	01	H5521_320_0	3	N	N		2																																																																				
H5521	322	0	1	04	01	H5521_322_0	2	N	N		2																																																																				
H5521	323	0	1	04	01	H5521_323_0	3	N	N		2																																																																				
H5521	324	0	1	04	01	H5521_324_0	2	N	N		2																																																																				
H5521	326	0	1	04	01	H5521_326_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	329	0	1	04	01	H5521_329_0	2	N	N		2																																																																				
H5521	330	0	1	04	01	H5521_330_0	2	N	N		2																																																																				
H5521	340	0	1	04	01	H5521_340_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	348	0	1	04	01	H5521_348_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	351	0	1	04	01	H5521_351_0	2	N	N		2																																																																				
H5521	352	0	1	04	01	H5521_352_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	353	0	1	04	01	H5521_353_0	2	N	N		2																																																																				
H5521	363	0	1	04	01	H5521_363_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	364	0	1	04	01	H5521_364_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	365	0	1	04	01	H5521_365_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	369	0	1	04	01	H5521_369_0	2	N	N		2																																																																				
H5521	375	0	1	04	01	H5521_375_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	378	0	1	04	01	H5521_378_0	2	N	N		2																																																																				
H5521	381	0	1	04	01	H5521_381_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	388	0	1	04	01	H5521_388_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	392	0	1	04	01	H5521_392_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	395	0	1	04	01	H5521_395_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	398	0	1	04	01	H5521_398_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5521	399	0	1	04	01	H5521_399_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	400	0	1	04	01	H5521_400_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	403	0	1	04	01	H5521_403_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	404	0	1	04	01	H5521_404_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	406	0	1	04	01	H5521_406_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	407	0	1	04	01	H5521_407_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	414	0	1	04	01	H5521_414_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	419	0	1	04	01	H5521_419_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	422	0	1	04	01	H5521_422_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	425	0	1	04	01	H5521_425_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	431	0	1	04	01	H5521_431_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	432	0	1	04	01	H5521_432_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	433	0	1	04	01	H5521_433_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	434	0	1	04	01	H5521_434_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	435	0	1	04	01	H5521_435_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	439	0	1	04	01	H5521_439_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	443	0	1	04	01	H5521_443_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	446	0	1	04	01	H5521_446_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	449	0	1	04	01	H5521_449_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	450	0	1	04	01	H5521_450_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	451	0	1	04	01	H5521_451_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	457	0	1	04	01	H5521_457_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	461	0	1	04	01	H5521_461_0	5				1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H5521	464	0	1	04	01	H5521_464_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5521	465	0	1	04	01	H5521_465_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5521	467	0	1	04	01	H5521_467_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	470	0	1	04	01	H5521_470_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	472	0	1	04	01	H5521_472_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5521	475	0	1	04	01	H5521_475_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	476	0	1	04	01	H5521_476_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	477	0	1	04	01	H5521_477_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	478	0	1	04	01	H5521_478_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	480	0	1	04	01	H5521_480_0	2	N	N		2																																																																				
H5521	482	0	1	04	01	H5521_482_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	484	0	1	04	01	H5521_484_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	487	0	1	04	01	H5521_487_0	2	N	N		2																																																																				
H5521	488	0	1	04	01	H5521_488_0	2	N	N		2																																																																				
H5521	490	0	1	04	01	H5521_490_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	492	0	1	04	01	H5521_492_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	493	0	1	04	01	H5521_493_0	2	N	N		2																																																																				
H5521	495	0	1	04	01	H5521_495_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	496	0	1	04	01	H5521_496_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	500	0	1	04	01	H5521_500_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	501	0	1	04	01	H5521_501_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	502	0	1	04	01	H5521_502_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	504	0	1	04	01	H5521_504_0	3	N	N		2																																																																				
H5521	506	0	1	04	01	H5521_506_0	5				1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H5521	510	0	1	04	01	H5521_510_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	512	0	1	04	01	H5521_512_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	513	0	1	04	01	H5521_513_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	520	0	1	04	01	H5521_520_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	521	0	1	04	01	H5521_521_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	522	0	1	04	01	H5521_522_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	536	0	1	04	01	H5521_536_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	537	0	1	04	01	H5521_537_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	553	0	1	04	01	H5521_553_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	554	0	1	04	01	H5521_554_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	558	0	1	04	01	H5521_558_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	569	0	1	04	01	H5521_569_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	578	0	1	04	01	H5521_578_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	580	0	1	04	01	H5521_580_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	581	0	1	04	01	H5521_581_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	586	0	1	04	01	H5521_586_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	598	0	1	04	01	H5521_598_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	607	0	1	04	01	H5521_607_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	609	0	1	04	01	H5521_609_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	644	0	1	04	01	H5521_644_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	645	0	1	04	01	H5521_645_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	646	0	1	04	01	H5521_646_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	649	0	1	04	01	H5521_649_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	650	0	1	04	01	H5521_650_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	652	0	1	04	01	H5521_652_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	654	0	1	04	01	H5521_654_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	656	0	1	04	01	H5521_656_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	661	0	1	04	01	H5521_661_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	662	0	1	04	01	H5521_662_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	664	0	1	04	01	H5521_664_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	665	0	1	04	01	H5521_665_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	669	0	1	04	01	H5521_669_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	674	0	1	04	01	H5521_674_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	676	0	1	04	01	H5521_676_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	685	0	1	04	01	H5521_685_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	686	0	1	04	01	H5521_686_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	687	0	1	04	01	H5521_687_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	688	0	1	04	01	H5521_688_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	698	0	1	04	01	H5521_698_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	699	0	1	04	01	H5521_699_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	702	0	1	04	01	H5521_702_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	704	0	1	04	01	H5521_704_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	705	0	1	04	01	H5521_705_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	706	0	1	04	01	H5521_706_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	710	0	1	04	01	H5521_710_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5521	801	0	1	04	01	H5521_801_0	2	N	N		2																																																																				
H5521	805	0	2	04	01	H5521_805_0	1	N	N		2																																																																				
H5522	001	0	1	04	01	H5522_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	002	0	1	04	01	H5522_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	004	0	1	04	01	H5522_004_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	005	0	1	04	01	H5522_005_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	013	0	1	04	01	H5522_013_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	014	0	1	04	01	H5522_014_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	017	0	1	04	01	H5522_017_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	022	0	1	04	01	H5522_022_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	028	0	1	04	01	H5522_028_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	029	0	1	04	01	H5522_029_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	032	0	1	04	01	H5522_032_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5522	802	0	1	04	01	H5522_802_0	1	N	N		2																																																																				
H5522	803	0	1	04	01	H5522_803_0	1				1																																																																				
H5522	808	0	2	04	01	H5522_808_0	1	N	N		2																																																																				
H5522	809	0	2	04	01	H5522_809_0	1				1																																																																				
H5522	810	0	1	04	01	H5522_810_0	1	N	N		2																																																																				
H5522	811	0	1	04	01	H5522_811_0	1				1																																																																				
H5522	813	0	2	04	01	H5522_813_0	1	N	N		2																																																																				
H5522	814	0	2	04	01	H5522_814_0	1				1																																																																				
H5522	815	0	1	04	01	H5522_815_0	1	N	N		2																																																																				
H5522	816	0	1	04	01	H5522_816_0	1				1																																																																				
H5522	817	0	2	04	01	H5522_817_0	1	N	N		2																																																																				
H5522	818	0	2	04	01	H5522_818_0	1				1																																																																				
H5522	819	0	1	04	01	H5522_819_0	1				1																																																																				
H5522	820	0	1	04	01	H5522_820_0	1	N	N		2																																																																				
H5522	821	0	1	04	01	H5522_821_0	1				1																																																																				
H5522	822	0	2	04	01	H5522_822_0	1				1																																																																				
H5522	823	0	1	04	01	H5522_823_0	1	N	N		2																																																																				
H5522	824	0	2	04	01	H5522_824_0	1				1																																																																				
H5522	825	0	2	04	01	H5522_825_0	1	N	N		2																																																																				
H5522	827	0	2	04	01	H5522_827_0	1	N	N		2																																																																				
H5522	828	0	1	04	01	H5522_828_0	1				1																																																																				
H5522	832	0	1	04	01	H5522_832_0	1				1																																																																				
H5522	836	0	1	04	01	H5522_836_0	1				1																																																																				
H5522	837	0	1	04	01	H5522_837_0	1	N	N		2																																																																				
H5522	838	0	2	04	01	H5522_838_0	1	N	N		2																																																																				
H5525	004	0	1	04	01	H5525_004_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	005	0	1	04	01	H5525_005_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	006	0	1	04	01	H5525_006_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	008	0	1	04	01	H5525_008_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	220.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	030	0	1	04	01	H5525_030_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	031	0	1	04	01	H5525_031_0	1	N	N		2																																																																				
H5525	034	0	1	04	01	H5525_034_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	035	0	1	04	01	H5525_035_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	036	0	1	04	01	H5525_036_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5525	041	0	1	04	01	H5525_041_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	042	0	1	04	01	H5525_042_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	045	0	1	04	01	H5525_045_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5525	046	0	1	04	01	H5525_046_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5525	049	0	1	04	01	H5525_049_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	050	0	1	04	01	H5525_050_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	051	1	1	04	01	H5525_051_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	051	2	1	04	01	H5525_051_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	054	0	1	04	01	H5525_054_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	056	0	1	04	01	H5525_056_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	057	0	1	04	01	H5525_057_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	059	0	1	04	01	H5525_059_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	065	0	1	04	01	H5525_065_0	2	N	N		2																																																																				
H5525	070	0	1	04	01	H5525_070_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	072	0	1	04	01	H5525_072_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5525	074	0	1	04	01	H5525_074_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	075	0	1	04	01	H5525_075_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	077	0	1	04	01	H5525_077_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	078	0	1	04	01	H5525_078_0	2	N	N		2																																																																				
H5525	079	0	1	04	01	H5525_079_0	1	N	N		2																																																																				
H5525	080	0	1	04	01	H5525_080_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	083	0	1	04	01	H5525_083_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5525	084	0	1	04	01	H5525_084_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	085	1	1	04	01	H5525_085_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	085	2	1	04	01	H5525_085_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	086	1	1	04	01	H5525_086_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	086	2	1	04	01	H5525_086_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	087	0	1	04	01	H5525_087_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5525	809	0	1	04	01	H5525_809_0	2				1																																																																				
H5525	810	0	1	04	01	H5525_810_0	1	N	N		2																																																																				
H5525	812	0	2	04	01	H5525_812_0	1				1																																																																				
H5525	813	0	2	04	01	H5525_813_0	1	N	N		2																																																																				
H5525	816	0	1	04	01	H5525_816_0	1				1																																																																				
H5525	817	0	1	04	01	H5525_817_0	1	N	N		2																																																																				
H5525	818	0	1	04	01	H5525_818_0	1				1																																																																				
H5525	819	0	1	04	01	H5525_819_0	1	N	N		2																																																																				
H5525	826	0	1	04	01	H5525_826_0	3				1																																																																				
H5525	827	0	1	04	01	H5525_827_0	1	N	N		2																																																																				
H5525	830	0	1	04	01	H5525_830_0	1				1																																																																				
H5525	831	0	1	04	01	H5525_831_0	1	N	N		2																																																																				
H5526	004	0	1	04	01	H5526_004_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5526	016	0	1	04	01	H5526_016_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5526	018	0	1	04	01	H5526_018_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H5526	023	0	1	04	01	H5526_023_0	4	N	N		2																																																																				
H5526	806	0	1	04	01	H5526_806_0	1	N	N		2																																																																				
H5526	808	0	1	04	01	H5526_808_0	1				1																																																																				
H5526	813	0	1	04	01	H5526_813_0	1				1																																																																				
H5528	807	0	1	04	01	H5528_807_0	2				1																																																																				
H5528	815	0	1	04	01	H5528_815_0	2	N	N		2																																																																				
H5533	003	0	1	04	01	H5533_003_0	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	005	0	1	04	01	H5533_005_0	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	008	0	1	04	01	H5533_008_0	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	011	0	1	04	01	H5533_011_0	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	013	0	1	04	01	H5533_013_0	18			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	.	2	3		0111100	1																																		1		1	1
H5533	015	1	1	04	01	H5533_015_1	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	015	2	1	04	01	H5533_015_2	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	015	3	1	04	01	H5533_015_3	17			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	015	4	1	04	01	H5533_015_4	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	015	6	1	04	01	H5533_015_6	16			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	016	1	1	04	01	H5533_016_1	14	N	N		2																																																																				
H5533	016	2	1	04	01	H5533_016_2	13	N	N		2																																																																				
H5533	017	1	1	04	01	H5533_017_1	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	017	2	1	04	01	H5533_017_2	15			5F	1	4	101101	1	2	1	1	5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The plan meets this requirement by offering a reduced deductible and zero dollar cost-share for Tier 1 and Tier 2 drugs at a preferred pharmacy.	2	3		0111100	1																																		1		1	1
H5533	801	0	1	04	01	H5533_801_0	4	N	N		2																																																																				
H5533	802	0	1	04	01	H5533_802_0	4				1																																																																				
H5533	803	0	1	04	01	H5533_803_0	4				1																																																																				
H5538	001	0	1	20	08	H5538_001_0	2				1																																																																				
H5538	002	0	1	20	08	H5538_002_0	2				1																																																																				
H5549	003	0	1	01	01	H5549_003_0	5		N		1	1	110110	1		1	1										615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	0	0	0	0	0	0	0		0			1	1
H5549	011	0	1	01	01	H5549_011_0	5		N	4A4	1	4	110110	1	2	1	1	5	4	2				Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0000010	1				1	1	101	Enhanced cost sharing for select care drugs	2	3		0111110	1																																		1	1	1	1
H5549	012	0	1	01	01	H5549_012_0	6			5A4	1	4	110110	1	2	1	1	6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	500.00	2	0100001	1				1	1	111	Lower deductible and enhanced cost sharing.	2	3		0111111	1																																				1	1
H5577	002	0	1	01	01	H5577_002_0	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	005	0	1	01	01	H5577_005_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	008	0	1	02	01	H5577_008_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	016	0	1	01	01	H5577_016_0	7	N	N		2																																																																				
H5577	017	0	1	01	01	H5577_017_0	8		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	038	0	1	01	01	H5577_038_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	042	0	1	01	01	H5577_042_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	043	0	1	01	01	H5577_043_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	044	0	1	01	01	H5577_044_0	10			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	046	0	1	01	01	H5577_046_0	9		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	052	0	1	01	01	H5577_052_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	054	1	1	01	01	H5577_054_1	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	054	2	1	01	01	H5577_054_2	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	054	3	1	01	01	H5577_054_3	9		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	056	1	1	01	01	H5577_056_1	10			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	056	2	1	01	01	H5577_056_2	10			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	056	4	1	01	01	H5577_056_4	10			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	059	0	1	01	01	H5577_059_0	8			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	060	0	1	01	01	H5577_060_0	9			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Plan uses cost-sharing to increase the actuarial value of Part D benefits above the actuarial value of the defined standard prescription drug coverage.	1	3		0001110	1																																				1	1
H5577	061	0	1	01	01	H5577_061_0	9		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	062	0	1	01	01	H5577_062_0	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	1	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H5577	801	0	1	01	01	H5577_801_0	3	N	N		2																																																																				
H5577	802	0	1	01	01	H5577_802_0	3				1																																																																				
H5577	809	0	1	01	01	H5577_809_0	3				1																																																																				
H5577	818	0	1	01	01	H5577_818_0	3				1																																																																				
H5577	820	0	1	01	01	H5577_820_0	3				1																																																																				
H5577	821	0	1	01	01	H5577_821_0	3				1																																																																				
H5577	822	0	1	01	01	H5577_822_0	3				1																																																																				
H5577	824	0	1	01	01	H5577_824_0	3				1																																																																				
H5577	827	0	1	01	01	H5577_827_0	3				1																																																																				
H5577	829	0	1	01	01	H5577_829_0	3				1																																																																				
H5577	830	0	1	01	01	H5577_830_0	3				1																																																																				
H5577	831	0	1	01	01	H5577_831_0	3				1																																																																				
H5577	833	1	1	02	01	H5577_833_1	3				1																																																																				
H5577	833	2	1	02	01	H5577_833_2	3				1																																																																				
H5577	833	3	1	02	01	H5577_833_3	3				1																																																																				
H5577	833	4	1	02	01	H5577_833_4	3				1																																																																				
H5577	833	5	1	02	01	H5577_833_5	3				1																																																																				
H5577	833	6	1	02	01	H5577_833_6	3				1																																																																				
H5577	833	7	1	02	01	H5577_833_7	3				1																																																																				
H5577	833	8	1	02	01	H5577_833_8	3				1																																																																				
H5577	833	9	1	02	01	H5577_833_9	3				1																																																																				
H5577	833	10	1	02	01	H5577_833_10	3				1																																																																				
H5577	834	1	1	02	01	H5577_834_1	3				1																																																																				
H5577	834	2	1	02	01	H5577_834_2	3				1																																																																				
H5577	834	3	1	02	01	H5577_834_3	3				1																																																																				
H5577	834	4	1	02	01	H5577_834_4	3				1																																																																				
H5577	834	5	1	02	01	H5577_834_5	3				1																																																																				
H5577	834	6	1	02	01	H5577_834_6	3				1																																																																				
H5577	834	7	1	02	01	H5577_834_7	3				1																																																																				
H5577	834	8	1	02	01	H5577_834_8	3				1																																																																				
H5577	834	9	1	02	01	H5577_834_9	3				1																																																																				
H5577	834	10	1	02	01	H5577_834_10	3				1																																																																				
H5577	835	1	1	02	01	H5577_835_1	3				1																																																																				
H5577	835	2	1	02	01	H5577_835_2	3				1																																																																				
H5577	835	3	1	02	01	H5577_835_3	3				1																																																																				
H5577	835	4	1	02	01	H5577_835_4	3				1																																																																				
H5577	835	5	1	02	01	H5577_835_5	3				1																																																																				
H5577	835	6	1	02	01	H5577_835_6	3				1																																																																				
H5577	835	7	1	02	01	H5577_835_7	3				1																																																																				
H5577	835	8	1	02	01	H5577_835_8	3				1																																																																				
H5577	835	9	1	02	01	H5577_835_9	3				1																																																																				
H5577	835	10	1	02	01	H5577_835_10	3				1																																																																				
H5577	836	1	1	02	01	H5577_836_1	3				1																																																																				
H5577	836	2	1	02	01	H5577_836_2	3				1																																																																				
H5577	836	3	1	02	01	H5577_836_3	3				1																																																																				
H5577	836	4	1	02	01	H5577_836_4	3				1																																																																				
H5577	836	5	1	02	01	H5577_836_5	3				1																																																																				
H5577	836	6	1	02	01	H5577_836_6	3				1																																																																				
H5577	836	7	1	02	01	H5577_836_7	3				1																																																																				
H5577	836	8	1	02	01	H5577_836_8	3				1																																																																				
H5577	836	9	1	02	01	H5577_836_9	3				1																																																																				
H5577	836	10	1	02	01	H5577_836_10	3				1																																																																				
H5577	837	1	1	02	01	H5577_837_1	3				1																																																																				
H5577	837	2	1	02	01	H5577_837_2	3				1																																																																				
H5577	837	3	1	02	01	H5577_837_3	3				1																																																																				
H5577	837	4	1	02	01	H5577_837_4	3				1																																																																				
H5577	837	5	1	02	01	H5577_837_5	3				1																																																																				
H5577	837	6	1	02	01	H5577_837_6	3				1																																																																				
H5577	837	7	1	02	01	H5577_837_7	3				1																																																																				
H5577	837	8	1	02	01	H5577_837_8	3				1																																																																				
H5577	837	9	1	02	01	H5577_837_9	3				1																																																																				
H5577	837	10	1	02	01	H5577_837_10	3				1																																																																				
H5577	838	0	1	01	01	H5577_838_0	3				1																																																																				
H5580	001	0	1	01	01	H5580_001_0	2		N		1	1	110110	1		2											615.00																110	31		100	01	31		100			100	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H5580	004	0	1	01	01	H5580_004_0	5		N		1	1	110110	1		2											615.00																110	31		100	01	31		100			100	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H5580	005	0	1	01	01	H5580_005_0	2		N		1	1	110110	1		2											615.00																110	31		100	01	31		100			100	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H5587	002	0	1	01	01	H5587_002_0	14		N		1	1	110110	1		2											615.00																111	31	62	100	01	31		111	31	62	100	1	34	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5590	008	0	1	01	01	H5590_008_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	490.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5590	010	0	1	01	01	H5590_010_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H5591	003	0	1	01	01	H5591_003_0	3	N	N		2																																																																				
H5591	006	1	1	02	01	H5591_006_1	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H5591	006	2	1	02	01	H5591_006_2	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H5591	016	0	1	02	01	H5591_016_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H5591	017	0	1	02	01	H5591_017_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	011		2	3		0001110	1																																		1		1	1
H5591	018	0	1	02	01	H5591_018_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	011		2	3		0001110	1																																		1		1	1
H5591	801	0	1	02	01	H5591_801_0	3				1																																																																				
H5591	802	0	1	02	01	H5591_802_0	3				1																																																																				
H5593	001	0	1	01	01	H5593_001_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5593	801	0	1	01	01	H5593_801_0	1	N	N		2																																																																				
H5594	001	0	1	01	01	H5594_001_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	002	0	1	01	01	H5594_002_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	016	0	1	01	01	H5594_016_0	7		N	4E1	1	4	110110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100010	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0111000	1																																		1	1	1	1
H5594	017	0	1	01	01	H5594_017_0	7		N	4E1	1	4	110110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		1	615.00	2	0100010	1				2	1	101	$0 cost sharing for select tiers. Excluded drug coverage.	1	3		0111000	1																																		1	1	1	1
H5594	019	0	1	01	01	H5594_019_0	4			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	022	0	1	01	01	H5594_022_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	026	0	1	01	01	H5594_026_0	4			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	028	0	1	01	01	H5594_028_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5594	029	0	1	01	01	H5594_029_0	6			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	030	0	1	01	01	H5594_030_0	5			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5594	031	0	1	01	01	H5594_031_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	032	0	1	01	01	H5594_032_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	034	0	1	01	01	H5594_034_0	5			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5594	035	0	1	01	01	H5594_035_0	5			4E	1	4	101110	1	2	1	1	4	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0111000	3																																				1	1
H5594	036	0	1	01	01	H5594_036_0	6			4E3	1	4	101110	1	2	1	1	5	3	2				Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								2	1	110	$0 cost sharing for select tiers. Reduced cost sharing for select tiers at preferred pharmacies. Excluded drug coverage.	1	3		0101010	3																																				1	1
H5599	002	0	1	02	01	H5599_002_0	9			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H5599	003	0	1	01	01	H5599_003_0	9		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5599	004	0	1	02	01	H5599_004_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5599	010	0	1	02	01	H5599_010_0	8	N	N		2																																																																				
H5599	013	1	1	01	01	H5599_013_1	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	580.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5599	013	2	1	01	01	H5599_013_2	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	580.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5608	001	0	1	01	01	H5608_001_0	7		N		1	1	110110	1		2											615.00																111	30	60	100	10		10	100			100	1	31	2	2	35.00	70.00	105.00			105.00		35.00	35.00	25	25	25			25		25	25			1	1
H5608	002	0	1	01	01	H5608_002_0	7			5A4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	110	Cost sharing has been reduced, which increases the plan paid amount per drug for these classes, therefore increasing the actuarial value.	2	3		0111111	1																																				1	1
H5610	001	0	1	20	08	H5610_001_0	2				1																																																																				
H5610	003	0	1	20	08	H5610_003_0	2				1																																																																				
H5619	001	0	1	01	01	H5619_001_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	003	0	1	01	01	H5619_003_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	310.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	012	0	1	01	01	H5619_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	015	0	1	01	01	H5619_015_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	016	0	1	01	01	H5619_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	021	0	1	01	01	H5619_021_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	026	0	1	01	01	H5619_026_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	038	0	1	01	01	H5619_038_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	490.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H5619	046	0	1	01	01	H5619_046_0	2			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5619	047	0	1	01	01	H5619_047_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	049	0	1	02	01	H5619_049_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	051	0	1	02	01	H5619_051_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	053	0	1	02	01	H5619_053_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	055	0	1	01	01	H5619_055_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5619	057	0	1	01	01	H5619_057_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	059	0	1	01	01	H5619_059_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	061	0	1	01	01	H5619_061_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	066	0	1	01	01	H5619_066_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	069	0	1	02	01	H5619_069_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	071	0	1	01	01	H5619_071_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	075	0	1	01	01	H5619_075_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	083	0	1	01	01	H5619_083_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	089	0	1	01	01	H5619_089_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	090	0	1	01	01	H5619_090_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	091	0	1	01	01	H5619_091_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	093	0	1	01	01	H5619_093_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	095	0	1	01	01	H5619_095_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	111	0	1	02	01	H5619_111_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	113	0	1	02	01	H5619_113_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	116	0	1	01	01	H5619_116_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	119	0	1	01	01	H5619_119_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	121	0	1	01	01	H5619_121_0	4	N	N		2																																																																				
H5619	122	0	1	01	01	H5619_122_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	123	0	1	02	01	H5619_123_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	126	0	1	02	01	H5619_126_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	133	0	1	01	01	H5619_133_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	135	0	1	01	01	H5619_135_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	137	0	1	01	01	H5619_137_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	143	0	1	01	01	H5619_143_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	145	0	1	01	01	H5619_145_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5619	146	0	1	01	01	H5619_146_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	147	0	1	01	01	H5619_147_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	148	0	1	01	01	H5619_148_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	150	0	1	01	01	H5619_150_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	151	0	1	01	01	H5619_151_0	2	N	N		2																																																																				
H5619	152	0	1	01	01	H5619_152_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	157	0	1	01	01	H5619_157_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	159	0	1	01	01	H5619_159_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	161	0	1	01	01	H5619_161_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5619	162	0	1	02	01	H5619_162_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	163	0	1	01	01	H5619_163_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	165	0	1	01	01	H5619_165_0	6		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	166	0	1	01	01	H5619_166_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	235.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	167	0	1	01	01	H5619_167_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	169	0	1	01	01	H5619_169_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	170	0	1	01	01	H5619_170_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H5619	171	0	1	01	01	H5619_171_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	173	0	1	01	01	H5619_173_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	174	0	1	01	01	H5619_174_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	177	0	1	01	01	H5619_177_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5619	178	0	1	01	01	H5619_178_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	179	0	1	02	01	H5619_179_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	180	0	1	01	01	H5619_180_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	181	0	1	01	01	H5619_181_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H5619	182	0	1	01	01	H5619_182_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H5619	183	0	1	01	01	H5619_183_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	184	0	1	01	01	H5619_184_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5619	802	0	1	01	01	H5619_802_0	3				1																																																																				
H5619	803	0	1	01	01	H5619_803_0	3	N	N		2																																																																				
H5619	805	0	1	01	01	H5619_805_0	3				1																																																																				
H5619	806	0	1	01	01	H5619_806_0	3	N	N		2																																																																				
H5622	001	0	1	20	08	H5622_001_0	2				1																																																																				
H5622	002	0	1	20	08	H5622_002_0	2				1																																																																				
H5628	001	0	1	01	01	H5628_001_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5628	012	0	1	01	01	H5628_012_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	375.00	2	0100001	1				1	1	111	Reduced deductible to $375. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5628	013	1	1	01	01	H5628_013_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5628	013	2	1	01	01	H5628_013_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5628	014	1	1	01	01	H5628_014_1	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5628	014	2	1	01	01	H5628_014_2	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5629	001	0	1	20	08	H5629_001_0	2				1																																																																				
H5629	002	0	1	20	08	H5629_002_0	2				1																																																																				
H5644	801	0	1	01	01	H5644_801_0	1	N	N		2																																																																				
H5644	802	0	1	01	01	H5644_802_0	1				1																																																																				
H5644	803	0	1	01	01	H5644_803_0	1				1																																																																				
H5649	001	0	1	01	01	H5649_001_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	No deductible. Reduced cost share on Tiers 1, 2, 3, 4 and 6.	1	3		0001110	1																																				1	1
H5649	009	0	1	01	01	H5649_009_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0100001	1				1	1	111	Reduced deductible to $250. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5649	018	0	1	01	01	H5649_018_0	9			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				1	1	111	The deductible is lowered to $100 and only applies to tiers 3, 4, and 5. Furthermore, cost sharing is reduced for tiers 1, 2, 3 and 6 in the coverage phase.	1	3		0001110	1																																				1	1
H5649	022	0	1	01	01	H5649_022_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	No deductible. Cost sharing is reduced for tiers 1, 2, 3, and 6 in the coverage phase.	1	3		0001110	1																																		1		1	1
H5649	023	0	1	01	01	H5649_023_0	10			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	125.00	2	0110001	1				1	1	111	The deductible is lowered to $125 and only applies to tiers 3, 4, and 5. Furthermore, cost sharing is reduced for tiers 1, 2, 3, and 6 in the coverage phase.	1	3		0001110	1																																		1		1	1
H5649	024	0	1	01	01	H5649_024_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	550.00	2	0110001	1				1	1	111	Reduced deductible to $550. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H5649	025	1	1	01	01	H5649_025_1	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	1	3		0001110	1																																		1		1	1
H5649	025	2	1	01	01	H5649_025_2	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	1	3		0001110	1																																		1		1	1
H5649	025	3	1	01	01	H5649_025_3	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	1	3		0001110	1																																		1		1	1
H5649	025	4	1	01	01	H5649_025_4	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	1	3		0001110	1																																		1		1	1
H5649	026	1	1	01	01	H5649_026_1	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H5649	026	2	1	01	01	H5649_026_2	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H5649	026	3	1	01	01	H5649_026_3	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H5649	026	4	1	01	01	H5649_026_4	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1		1	1
H5649	027	0	1	01	01	H5649_027_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	99.00	2	0100001	1				1	1	111	Reduced deductible to $99. Cost sharing is reduced for tiers 1, 2 and 6. Deductible does not apply to tiers 1 and 6.	1	3		0001110	1																																				1	1
H5649	028	0	1	01	01	H5649_028_0	10			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	110.00	2	0110001	1				1	1	111	The deductible is lowered to $110 and only applies to tiers 3, 4, and 5. Furthermore, cost sharing is reduced for tiers 1, 2, 3, and 6 in the coverage phase.	1	3		0001110	1																																		1		1	1
H5649	029	0	1	01	01	H5649_029_0	11			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	Cost sharing is reduced for tiers 1, 2, 3, 4, and 6 in the coverage phase.	1	3		0001110	1																																				1	1
H5649	030	0	1	01	01	H5649_030_0	8	N	N		2																																																																				
H5652	001	0	1	02	01	H5652_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5652	002	0	1	02	01	H5652_002_0	4	N	N		2																																																																				
H5652	003	0	1	02	01	H5652_003_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	Members have no deductible, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5652	004	0	1	02	01	H5652_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5652	006	0	1	02	01	H5652_006_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5652	008	0	1	02	01	H5652_008_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H5692	001	0	1	01	01	H5692_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	The cost sharing has been reduced below the Defined Standard levels	2	3		0011100	1																																		1	1	1	1
H5703	001	0	1	01	01	H5703_001_0	4		N		1	1	110100	1		2											615.00																110	30		90	01	30		000				1	31	1	1	35.00		105.00				35.00		35.00	25		25				25		25			1	1
H5718	001	0	1	04	01	H5718_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5718	002	0	1	04	01	H5718_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5718	003	0	1	04	01	H5718_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H5718	004	0	1	04	01	H5718_004_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5718	005	0	1	04	01	H5718_005_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5718	006	0	1	04	01	H5718_006_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H5734	001	0	1	01	01	H5734_001_0	5		N	5A4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	001		2	3		0111111	1																																		1	1	1	1
H5774	022	0	1	01	01	H5774_022_0	5			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	028	0	1	01	01	H5774_028_0	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	1	0.00		0.00			0.00	0.00		0.00	0		0			0	0		0			1	1
H5774	031	0	1	02	01	H5774_031_0	5			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	035	0	1	01	01	H5774_035_0	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	0		0			0	0		0			1	1
H5774	038	0	1	01	01	H5774_038_0	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	041	1	1	01	01	H5774_041_1	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	041	2	1	01	01	H5774_041_2	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	041	3	1	01	01	H5774_041_3	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	041	4	1	01	01	H5774_041_4	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	041	5	1	01	01	H5774_041_5	5		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	043	1	1	01	01	H5774_043_1	6		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	043	2	1	01	01	H5774_043_2	6		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	043	3	1	01	01	H5774_043_3	6		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	043	4	1	01	01	H5774_043_4	7		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	043	5	1	01	01	H5774_043_5	7		N		1	1	110110	1		1	1										615.00																110	30		90	01	30		100			90	1	31	1	2	0.00		0.00			0.00	0.00		0.00	25		25			25	25		25			1	1
H5774	046	0	1	01	01	H5774_046_0	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	047	1	1	01	01	H5774_047_1	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	047	2	1	01	01	H5774_047_2	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	047	3	1	01	01	H5774_047_3	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	047	4	1	01	01	H5774_047_4	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	047	5	1	01	01	H5774_047_5	6			5A4	1	4	101110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	Our Enhanced plan offerings include supplemental Part D benefits that are significantly richer than standard Part D. We offer $0 cost sharing on our preferred generic, non-preferred generic, and Select Care tiers, and brand copays that are significantly below the maximum amounts allowed by CMS (including $0 preferred brand drugs in some instances). As such, the benefits offered with our plans are expected to meet any required actuarial value requirements relative to the standard benefit.	1	3		0000101	1																																				1	1
H5774	802	0	1	01	01	H5774_802_0	2	N	N		2																																																																				
H5774	808	0	1	01	01	H5774_808_0	2				1																																																																				
H5774	809	0	1	01	01	H5774_809_0	2				1																																																																				
H5774	810	0	1	01	01	H5774_810_0	2				1																																																																				
H5774	811	0	1	01	01	H5774_811_0	2				1																																																																				
H5774	812	0	1	02	01	H5774_812_0	2				1																																																																				
H5774	814	0	1	02	01	H5774_814_0	2				1																																																																				
H5774	816	0	1	02	01	H5774_816_0	2				1																																																																				
H5774	818	0	1	02	01	H5774_818_0	2				1																																																																				
H5774	820	0	1	02	01	H5774_820_0	2				1																																																																				
H5774	821	0	1	02	01	H5774_821_0	2				1																																																																				
H5774	822	0	1	02	01	H5774_822_0	2				1																																																																				
H5774	823	0	1	02	01	H5774_823_0	2				1																																																																				
H5774	824	0	1	02	01	H5774_824_0	2				1																																																																				
H5774	825	0	1	02	01	H5774_825_0	2				1																																																																				
H5774	826	0	1	01	01	H5774_826_0	2				1																																																																				
H5774	827	0	1	01	01	H5774_827_0	2				1																																																																				
H5774	828	0	1	01	01	H5774_828_0	2				1																																																																				
H5774	829	0	1	01	01	H5774_829_0	2				1																																																																				
H5774	830	0	1	01	01	H5774_830_0	2				1																																																																				
H5774	831	0	1	01	01	H5774_831_0	2				1																																																																				
H5779	002	0	1	01	01	H5779_002_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5779	007	0	1	01	01	H5779_007_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5779	009	0	1	01	01	H5779_009_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5779	010	0	1	01	01	H5779_010_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5779	011	0	1	01	01	H5779_011_0	6	N	N		2																																																																				
H5793	001	0	1	02	01	H5793_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	010	0	1	02	01	H5793_010_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	014	0	1	02	01	H5793_014_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	015	0	1	02	01	H5793_015_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	017	0	1	02	01	H5793_017_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5793	018	0	1	02	01	H5793_018_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	019	0	1	02	01	H5793_019_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible, waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H5793	020	0	1	02	01	H5793_020_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H5793	801	0	1	01	01	H5793_801_0	1	N	N		2																																																																				
H5793	802	0	1	01	01	H5793_802_0	1				1																																																																				
H5810	014	0	1	01	01	H5810_014_0	8			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	There is no deductible.  Cost sharing is reduced on tiers 1, 2, and 6.	2	3		0001110	1																																		1		1	1
H5822	001	0	1	20	08	H5822_001_0	2				1																																																																				
H5822	002	0	1	20	08	H5822_002_0	2				1																																																																				
H5823	010	0	1	01	01	H5823_010_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				1	1	111	Reduced deductible to $350. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H5823	013	1	1	01	01	H5823_013_1	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3,  and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5823	013	2	1	01	01	H5823_013_2	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3,  and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5826	014	0	1	01	01	H5826_014_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Cost shares reduced below defined standard levels	2	3		0001100	1																																		1	1	1	1
H5826	017	0	1	01	01	H5826_017_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Cost shares reduced below defined standard levels.	2	3		0001100	1																																		1	1	1	1
H5828	001	0	1	01	01	H5828_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5828	002	0	1	01	01	H5828_002_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5828	008	0	1	02	01	H5828_008_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	390.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1		1	1
H5828	013	0	1	02	01	H5828_013_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5828	014	0	1	02	01	H5828_014_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5828	015	0	1	02	01	H5828_015_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	235.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5828	016	0	1	02	01	H5828_016_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5828	017	0	1	02	01	H5828_017_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5828	018	0	1	01	01	H5828_018_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5843	001	0	1	01	01	H5843_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	440.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of Defined Standard prescription drug coverage by offering reduced cost sharing on tier 1 and tier 2 and by reducing the Part D deductible from the Defined Standard amount. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H5852	001	0	1	01	01	H5852_001_0	6			4A4	1	3	110100	1	2	2		5	4	2				Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0000010	1				1					3		0110100	1																																		1		1	1
H5854	012	0	1	02	01	H5854_012_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H5854	013	0	1	01	01	H5854_013_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5854	018	0	1	02	01	H5854_018_0	4	N	N		2																																																																				
H5854	019	1	1	01	01	H5854_019_1	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	215.00	2	0110001	1				2	1	111	$0 cost sharing on select tiersReduced cost sharing for select tiers at preferred pharmacies	2	3		0001100	1																																		1		1	1
H5854	019	2	1	01	01	H5854_019_2	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	215.00	2	0110001	1				2	1	111	$0 cost sharing on select tiersReduced cost sharing for select tiers at preferred pharmacies	2	3		0001100	1																																		1		1	1
H5854	020	0	1	01	01	H5854_020_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H5854	801	0	1	01	01	H5854_801_0	4				1																																																																				
H5854	803	0	1	01	01	H5854_803_0	3	N	N		2																																																																				
H5854	806	0	2	01	01	H5854_806_0	3				1																																																																				
H5854	807	0	2	01	01	H5854_807_0	3	N	N		2																																																																				
H5854	809	0	1	01	01	H5854_809_0	3	N	N		2																																																																				
H5854	811	0	2	01	01	H5854_811_0	4	N	N		2																																																																				
H5859	001	0	1	01	01	H5859_001_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan has $0 deductible and $0 copay for Tier 6 drugs	1	3		0001100	3																																		1	1	1	1
H5883	001	1	1	02	01	H5883_001_1	6	N	N		2																																																																				
H5883	001	2	1	02	01	H5883_001_2	6	N	N		2																																																																				
H5883	001	3	1	02	01	H5883_001_3	6	N	N		2																																																																				
H5883	001	4	1	02	01	H5883_001_4	6	N	N		2																																																																				
H5883	001	5	1	02	01	H5883_001_5	6	N	N		2																																																																				
H5883	002	1	1	02	01	H5883_002_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	002	2	1	02	01	H5883_002_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	002	3	1	02	01	H5883_002_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	002	4	1	02	01	H5883_002_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	002	7	1	02	01	H5883_002_7	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	003	1	1	02	01	H5883_003_1	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	003	2	1	02	01	H5883_003_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	003	3	1	02	01	H5883_003_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	003	4	1	02	01	H5883_003_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	003	5	1	02	01	H5883_003_5	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	007	0	1	01	01	H5883_007_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	125.00	2	0110000	1				1	1	111	We fulfill the requirement through reduced deductibles and/or copays/coinsurance	2	3		0001110	1																																		1		1	1
H5883	014	1	1	02	01	H5883_014_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	014	2	1	02	01	H5883_014_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	014	4	1	02	01	H5883_014_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	014	5	1	02	01	H5883_014_5	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H5883	801	0	1	02	01	H5883_801_0	2	N	N		2																																																																				
H5883	805	0	1	02	01	H5883_805_0	2				1																																																																				
H5900	001	0	1	04	01	H5900_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Minimally, we offer the following enhancements over the DS benefit:   lower deductible, lower cost-sharing in the ICL phase, $0 mail order.	2	3		0001110	1																																		1		1	1
H5900	004	0	1	04	01	H5900_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Minimally, we offer the following enhancements over the DS benefit:   lower deductible, lower cost-sharing in the ICL phase, $0 mail order.	2	3		0001110	1																																		1		1	1
H5900	006	0	1	04	01	H5900_006_0	4	N	N		2																																																																				
H5900	007	0	1	04	01	H5900_007_0	4	N	N		2																																																																				
H5900	008	0	1	04	01	H5900_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Minimally, we offer the following enhancements over the DS benefit:   lower deductible, lower cost-sharing in the ICL phase, $0 mail order.	2	3		0001110	1																																		1		1	1
H5900	801	0	1	04	01	H5900_801_0	4				1																																																																				
H5900	802	0	1	04	01	H5900_802_0	4	N	N		2																																																																				
H5902	001	0	1	20	08	H5902_001_0	2				1																																																																				
H5902	002	0	1	20	08	H5902_002_0	2				1																																																																				
H5926	001	0	1	01	01	H5926_001_0	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	425.00	2	0100001	1				1	1	111	Reduced deductible to $425. Reduced cost share on Tiers 1 , 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5926	008	0	1	01	01	H5926_008_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				1	1	111	Reduced deductible to $100. Reduced cost share on Tiers 1 , 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H5926	009	0	1	01	01	H5926_009_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	600.00	2	0110001	1				1	1	111	Reduced deductible to $600. Reduced cost share on Tiers 1 , 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H5928	004	0	1	01	01	H5928_004_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H5928	010	0	1	01	01	H5928_010_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	425.00	2	0110000	1				1	1	111	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs on Tiers 1 and 2 in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H5932	001	0	1	01	01	H5932_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5932	009	0	1	01	01	H5932_009_0	6		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5932	012	0	1	01	01	H5932_012_0	6		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5932	013	0	1	01	01	H5932_013_0	6		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5934	001	0	1	20	08	H5934_001_0	2				1																																																																				
H5934	002	0	1	20	08	H5934_002_0	2				1																																																																				
H5937	001	0	1	01	01	H5937_001_0	13		N		1	1	110110	1		2											615.00																111	30	60	100	10		29	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	70.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H5938	001	0	1	01	01	H5938_001_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				1	1	111	$250 deductible applies to tiers 3, 4 and 5 only and there is no deductible for tiers 1, 2 and 6.	2	3		0001100	1																																				1	1
H5938	006	0	1	01	01	H5938_006_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	111	$200 deductible applies to tiers 3, 4 and 5 only and there is no deductible for tiers 1, 2 and 6.	2	3		0001100	1																																				1	1
H5938	008	0	1	01	01	H5938_008_0	8			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				1	1	111	This plan offers a reduced deductible and the share of cost for all Tiers are lower than the standard retail amounts.	2	3		0001100	1																																				1	1
H5938	009	0	1	01	01	H5938_009_0	8			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				1	1	111	This plan offers a reduced deductible and the share of cost for all Tiers are lower than the standard retail amounts.	2	3		0001100	1																																				1	1
H5938	802	0	1	01	01	H5938_802_0	6				1																																																																				
H5938	803	0	1	01	01	H5938_803_0	6	N	N		2																																																																				
H5938	804	0	1	01	01	H5938_804_0	6				1																																																																				
H5938	805	0	1	01	01	H5938_805_0	6				1																																																																				
H5943	003	0	1	02	01	H5943_003_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0100000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tier 1, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5943	004	0	1	02	01	H5943_004_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	490.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers, a Part D deductible waived for Tiers 1 and 2, and reduced Part D deductible for other formulary tiers.	2	3		0001100	1																																		1		1	1
H5945	001	0	1	01	01	H5945_001_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	275.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H5945	002	0	1	01	01	H5945_002_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H5945	013	0	1	01	01	H5945_013_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT)	1	3		0011010	1																																		1		1	1
H5945	014	0	1	01	01	H5945_014_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT)	1	3		0011010	1																																		1		1	1
H5945	016	0	1	01	01	H5945_016_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0111001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H5945	017	0	1	01	01	H5945_017_0	6		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1	1	1	1
H5945	018	0	1	01	01	H5945_018_0	7		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1	1	1	1
H5945	027	0	1	01	01	H5945_027_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H5945	032	0	1	01	01	H5945_032_0	6	N	N		2																																																																				
H5945	801	0	1	01	01	H5945_801_0	1	N	N		2																																																																				
H5945	802	0	1	01	01	H5945_802_0	1				1																																																																				
H5945	804	0	1	01	01	H5945_804_0	1	N	N		2																																																																				
H5945	805	0	1	01	01	H5945_805_0	1				1																																																																				
H5959	009	0	1	04	01	H5959_009_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	010	1	1	04	01	H5959_010_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	010	2	1	04	01	H5959_010_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	011	0	1	04	01	H5959_011_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	012	0	1	04	01	H5959_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		1	3		0111100	3																																		1		1	1
H5959	013	1	1	04	01	H5959_013_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		1	3		0111100	3																																		1		1	1
H5959	013	2	1	04	01	H5959_013_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		1	3		0111100	3																																		1		1	1
H5959	014	1	1	04	01	H5959_014_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	014	2	1	04	01	H5959_014_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H5959	015	0	1	04	01	H5959_015_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		1	3		0111100	3																																		1		1	1
H5959	016	0	1	04	01	H5959_016_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	550.00	2	0110000	1				2	1	011		1	3		0111100	3																																		1		1	1
H5959	018	0	1	04	01	H5959_018_0	3	N	N		2																																																																				
H5959	801	0	1	04	01	H5959_801_0	1				1																																																																				
H5959	807	0	1	04	01	H5959_807_0	1	N	N		2																																																																				
H5959	808	0	1	04	01	H5959_808_0	1				1																																																																				
H5959	809	0	1	04	01	H5959_809_0	1				1																																																																				
H5965	003	0	1	04	01	H5965_003_0	7	N	N		2																																																																				
H5965	004	0	1	04	01	H5965_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	495.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H5965	006	0	1	04	01	H5965_006_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	605.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H5965	008	0	1	04	01	H5965_008_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H5969	002	0	1	01	01	H5969_002_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Cost sharing reduced below defined standard	2	3		0001110	1																																		1	1	1	1
H5969	003	0	1	01	01	H5969_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Cost sharing reduced below defined standard	2	3		0001110	1																																		1	1	1	1
H5970	016	0	1	04	01	H5970_016_0	3	N	N		2																																																																				
H5970	020	0	1	04	01	H5970_020_0	7		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H5970	028	0	1	04	01	H5970_028_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5970	029	0	1	04	01	H5970_029_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H5970	030	0	1	04	01	H5970_030_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5970	031	0	1	04	01	H5970_031_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5970	032	0	1	04	01	H5970_032_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H5970	801	0	1	04	01	H5970_801_0	2				1																																																																				
H5970	802	0	1	04	01	H5970_802_0	3	N	N		2																																																																				
H5970	805	0	2	04	01	H5970_805_0	1				1																																																																				
H5970	806	0	2	04	01	H5970_806_0	1	N	N		2																																																																				
H5970	816	0	1	04	01	H5970_816_0	1				1																																																																				
H5970	817	0	1	04	01	H5970_817_0	1	N	N		2																																																																				
H5970	818	0	1	04	01	H5970_818_0	1				1																																																																				
H5970	819	0	1	04	01	H5970_819_0	1	N	N		2																																																																				
H5970	822	0	1	04	01	H5970_822_0	1				1																																																																				
H5970	823	0	1	04	01	H5970_823_0	1	N	N		2																																																																				
H5970	828	0	1	04	01	H5970_828_0	1				1																																																																				
H5970	829	0	1	04	01	H5970_829_0	1	N	N		2																																																																				
H5978	001	0	1	20	08	H5978_001_0	2				1																																																																				
H5978	002	0	1	20	08	H5978_002_0	2				1																																																																				
H5989	011	0	1	01	01	H5989_011_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	1	3		0111111	3																																		1		1	1
H5991	010	0	1	01	01	H5991_010_0	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5991	012	1	1	01	01	H5991_012_1	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5991	012	2	1	01	01	H5991_012_2	4		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5991	013	1	1	01	01	H5991_013_1	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5991	013	2	1	01	01	H5991_013_2	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H5992	007	0	1	01	01	H5992_007_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H5992	010	0	1	01	01	H5992_010_0	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	199.00	2	0100001	1				1	1	111	Reduced deductible to $199. Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1, and 6.	2	3		0001110	1																																		1	1	1	1
H5993	001	0	1	20	08	H5993_001_0	2				1																																																																				
H5993	002	0	1	20	08	H5993_002_0	2				1																																																																				
H5995	004	0	1	01	01	H5995_004_0	7			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H6018	002	0	1	04	01	H6018_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6018	003	0	1	04	01	H6018_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6018	007	0	1	04	01	H6018_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6018	008	0	1	04	01	H6018_008_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6018	010	0	1	04	01	H6018_010_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6018	011	0	1	04	01	H6018_011_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6019	001	0	1	01	01	H6019_001_0	4		N	2A	1	4	110110	1	2	1	1	2	2	2				Generic, Brand		1	615.00	1						1	1	100	HPSM enhances the Part D benefit design by lowering the tier 1 coinsurance from 25% for members to 24% for members, enhancing the actuarial value of the benefit design compared to DS	1	3		0110000	1																																		1		1	1
H6059	001	0	1	20	08	H6059_001_0	2				1																																																																				
H6059	002	0	1	20	08	H6059_002_0	2				1																																																																				
H6078	801	0	1	04	01	H6078_801_0	3				1																																																																				
H6078	802	0	1	04	01	H6078_802_0	3	N	N		2																																																																				
H6078	803	0	1	04	01	H6078_803_0	3				1																																																																				
H6078	804	0	1	04	01	H6078_804_0	3	N	N		2																																																																				
H6078	805	0	2	04	01	H6078_805_0	3				1																																																																				
H6078	806	0	2	04	01	H6078_806_0	3	N	N		2																																																																				
H6079	001	0	1	20	08	H6079_001_0	2				1																																																																				
H6079	002	0	1	20	08	H6079_002_0	2				1																																																																				
H6081	001	0	1	20	08	H6081_001_0	3				1																																																																				
H6081	002	0	1	20	08	H6081_002_0	3				1																																																																				
H6130	801	0		07	02	H6130_801_0	1	N	N		2																																																																				
H6130	802	0		07	02	H6130_802_0	1	N	N		2																																																																				
H6130	803	0		07	02	H6130_803_0	1	N	N		2																																																																				
H6130	804	0		07	02	H6130_804_0	1	N	N		2																																																																				
H6130	805	0		07	02	H6130_805_0	1	N	N		2																																																																				
H6130	806	0		07	02	H6130_806_0	1	N	N		2																																																																				
H6130	807	0		07	02	H6130_807_0	1	N	N		2																																																																				
H6130	808	0		07	02	H6130_808_0	1	N	N		2																																																																				
H6130	809	0		07	02	H6130_809_0	1	N	N		2																																																																				
H6130	810	0		07	02	H6130_810_0	1	N	N		2																																																																				
H6130	811	0		07	02	H6130_811_0	1	N	N		2																																																																				
H6130	812	0		07	02	H6130_812_0	1	N	N		2																																																																				
H6130	813	0		07	02	H6130_813_0	1	N	N		2																																																																				
H6130	814	0		07	02	H6130_814_0	1	N	N		2																																																																				
H6130	815	0		07	02	H6130_815_0	1	N	N		2																																																																				
H6130	816	0		07	02	H6130_816_0	1	N	N		2																																																																				
H6130	817	0		07	02	H6130_817_0	1	N	N		2																																																																				
H6130	818	0		07	02	H6130_818_0	1	N	N		2																																																																				
H6147	001	0	1	20	08	H6147_001_0	2				1																																																																				
H6147	002	0	1	20	08	H6147_002_0	2				1																																																																				
H6154	001	0	1	02	01	H6154_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H6158	001	0	1	01	01	H6158_001_0	5			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	460.00	2	0110000	1				2	1	111	$0 cost sharing for generics on Tier 1$5 cost sharing for drugs on Tier 217% coinsurance for drugs on Tier 3	2	3		0001110	1																																		1		1	1
H6158	003	0	1	01	01	H6158_003_0	5			5F	1	3	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H6170	001	0	1	02	01	H6170_001_0	9			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6170	002	0	1	02	01	H6170_002_0	12			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6170	003	0	1	02	01	H6170_003_0	10			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6170	007	0	1	01	01	H6170_007_0	8			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6170	008	0	1	01	01	H6170_008_0	7			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6170	009	0	1	01	01	H6170_009_0	11			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6170	010	0	1	01	01	H6170_010_0	10			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6188	001	0	1	20	08	H6188_001_0	2				1																																																																				
H6188	002	0	1	20	08	H6188_002_0	2				1																																																																				
H6200	001	0	1	04	01	H6200_001_0	9			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	004	0	1	04	01	H6200_004_0	8			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	006	0	1	04	01	H6200_006_0	8			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	008	0	1	04	01	H6200_008_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers . This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	009	0	1	04	01	H6200_009_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	010	0	1	04	01	H6200_010_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	011	0	1	04	01	H6200_011_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers . This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0111110	3																																		1		1	1
H6200	801	0	1	04	01	H6200_801_0	1				1																																																																				
H6200	802	0	1	04	01	H6200_802_0	1				1																																																																				
H6200	803	0	1	04	01	H6200_803_0	1	N	N		2																																																																				
H6200	804	0	1	04	01	H6200_804_0	1	N	N		2																																																																				
H6202	003	0	1	04	01	H6202_003_0	5	N	N		2																																																																				
H6202	004	0	1	04	01	H6202_004_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Minimally, we offer the following enhancements over the DS benefit:   lower deductible, lower cost-sharing in the ICL phase and $0 mail order.	2	3		0001110	1																																		1		1	1
H6202	005	0	1	04	01	H6202_005_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Minimally, we offer the following enhancements over the DS benefit:   lower deductible, lower cost-sharing in the ICL phase and $0 mail order.	2	3		0001110	1																																		1		1	1
H6202	801	0	1	04	01	H6202_801_0	4				1																																																																				
H6202	802	0	1	04	01	H6202_802_0	4				1																																																																				
H6202	803	0	1	04	01	H6202_803_0	4				1																																																																				
H6202	804	0	1	04	01	H6202_804_0	4	N	N		2																																																																				
H6202	805	0	2	04	01	H6202_805_0	4				1																																																																				
H6224	001	0	1	01	01	H6224_001_0	5		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H6231	001	0	1	20	08	H6231_001_0	3				1																																																																				
H6231	002	0	1	20	08	H6231_002_0	3				1																																																																				
H6237	009	0	1	01	01	H6237_009_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	50.00	2	0110000	1				2	1	011		2	3		0111100	1																																		1		1	1
H6248	001	0	1	01	01	H6248_001_0	4			5A4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	110	The plan offers cost sharing benefits that are less than defined standard benefits	2	3		0111111	1																																		1		1	1
H6251	001	0	1	20	08	H6251_001_0	3				1																																																																				
H6251	002	0	1	20	08	H6251_002_0	3				1																																																																				
H6309	001	0	1	04	01	H6309_001_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H6309	002	0	1	04	01	H6309_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				1	1	111	This plan fulfills this requirement by reducing or eliminating the DS deductible and reducing cost-sharing in the initial coverage phase.	2	3		0011100	1																																		1		1	1
H6309	801	0	1	04	01	H6309_801_0	1				1																																																																				
H6309	802	0	1	04	01	H6309_802_0	2	N	N		2																																																																				
H6316	002	0	1	01	01	H6316_002_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H6316	005	0	1	01	01	H6316_005_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H6317	001	0	1	20	08	H6317_001_0	2				1																																																																				
H6317	002	0	1	20	08	H6317_002_0	2				1																																																																				
H6322	001	0	1	01	01	H6322_001_0	7			5A4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, we made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; We incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on tiers 1 & 2; thus reducing the cost sharing in the initial phases.	2	3		0111111	1																																		1		1	1
H6322	002	0	1	01	01	H6322_002_0	7			5A4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	500.00	2	0110001	1				2	1	111	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, we made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; We incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on tiers 1 & 2; thus reducing the cost sharing in the initial phases.	2	3		0111111	1																																		1		1	1
H6322	008	0	1	01	01	H6322_008_0	8			5A4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	To fulfill the requirement of increasing the actuarial value of benefits above the actuarial value of the defined standard prescription drug coverage, we made changes to enhance the value of benefits. While the Standard benefit has an approximate co-insurance benefit; We incorporated a flat-tiered benefit to each member understanding of the benefit by introducing a flat copay structure on tiers 1 & 2; thus reducing the cost sharing in the initial phases.	2	3		0111111	1																																		1		1	1
H6341	001	0	1	01	01	H6341_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H6342	001	0	1	20	08	H6342_001_0	3				1																																																																				
H6342	002	0	1	20	08	H6342_002_0	3				1																																																																				
H6345	001	0	1	01	01	H6345_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H6345	002	0	1	01	01	H6345_002_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H6348	002	0	1	04	01	H6348_002_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6348	005	0	1	04	01	H6348_005_0	8	N	N		2																																																																				
H6348	008	0	1	04	01	H6348_008_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6348	009	0	1	04	01	H6348_009_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	380.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H6351	001	0	1	01	01	H6351_001_0	7				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	1	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H6351	004	0	1	01	01	H6351_004_0	8			5F3	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs		3								1	1	010		2	3		0000101	1																																				1	1
H6351	005	0	1	01	01	H6351_005_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	1	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H6368	001	0	1	01	01	H6368_001_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								4	1	010		1	3		0111111	3																																				1	1
H6368	002	0	1	01	01	H6368_002_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								4	1	010		1	3		0111111	3																																		1		1	1
H6371	001	0	1	20	08	H6371_001_0	2				1																																																																				
H6371	002	0	1	20	08	H6371_002_0	2				1																																																																				
H6378	001	0	1	01	01	H6378_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H6379	001	0	1	01	01	H6379_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H6379	002	0	1	01	01	H6379_002_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H6396	017	0	1	01	01	H6396_017_0	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The plan is reducing cost share on tier 1 drugs to $0	2	3		0001100	1																																		1	1	1	1
H6399	001	0	1	01	01	H6399_001_0	3		N		1	1	110110	1		2											615.00																111	30	60	100	10		10	111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H6425	001	0	1	20	08	H6425_001_0	2				1																																																																				
H6425	002	0	1	20	08	H6425_002_0	2				1																																																																				
H6453	013	1	1	02	01	H6453_013_1	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	013	2	1	02	01	H6453_013_2	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	013	3	1	02	01	H6453_013_3	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	013	4	1	02	01	H6453_013_4	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	013	5	1	02	01	H6453_013_5	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	017	1	1	02	01	H6453_017_1	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	017	2	1	02	01	H6453_017_2	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	018	1	1	02	01	H6453_018_1	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	018	2	1	02	01	H6453_018_2	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	019	0	1	02	01	H6453_019_0	13		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	001		2	3		0001100	1																																		1	1	1	1
H6453	020	1	1	02	01	H6453_020_1	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	020	2	1	02	01	H6453_020_2	12			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	Reduction of deductible and reduction of copays at preferred pharmacies for certain tiers.	2	3		0001100	1																																		1		1	1
H6453	801	0	1	01	01	H6453_801_0	8				1																																																																				
H6453	802	0	1	01	01	H6453_802_0	8				1																																																																				
H6453	803	0	1	01	01	H6453_803_0	8	N	N		2																																																																				
H6453	804	0	1	02	01	H6453_804_0	8				1																																																																				
H6474	001	0	1	02	01	H6474_001_0	8			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6474	002	0	1	02	01	H6474_002_0	9			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6474	003	0	1	02	01	H6474_003_0	8			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6474	007	0	1	01	01	H6474_007_0	8			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6474	008	0	1	01	01	H6474_008_0	7			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	110	No plan deductible. Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																				1	1
H6474	009	0	1	01	01	H6474_009_0	11			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6474	010	0	1	01	01	H6474_010_0	11			5A4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Copay instead of coinsurance (including $0 copay for preferred generic tier) under ICL.	1	3		0111111	1																																		1		1	1
H6515	001	0	1	01	01	H6515_001_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H6515	002	0	1	01	01	H6515_002_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	199.00	2	0110001	1				1	1	111	Reduced deductible to $199. Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H6515	003	0	1	01	01	H6515_003_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H6515	004	0	1	01	01	H6515_004_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	199.00	2	0110001	1				1	1	111	Reduced deductible to $199. Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H6515	005	0	1	01	01	H6515_005_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H6517	001	0	1	20	08	H6517_001_0	2				1																																																																				
H6517	002	0	1	20	08	H6517_002_0	2				1																																																																				
H6529	004	0	1	01	01	H6529_004_0	7			5A4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				3	1	111	This plan offers both a reduced deductible and average coinsurance less than the defined standard benefit and passes all WS5 Alternative Coverage Tests.	1	3		0111111	1																																		1		1	1
H6537	001	0	1	20	08	H6537_001_0	2				1																																																																				
H6537	002	0	1	20	08	H6537_002_0	2				1																																																																				
H6541	001	0	1	20	08	H6541_001_0	2				1																																																																				
H6541	002	0	1	20	08	H6541_002_0	2				1																																																																				
H6545	001	0	1	04	01	H6545_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6545	010	0	1	04	01	H6545_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6550	003	0	1	02	01	H6550_003_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6550	004	0	1	02	01	H6550_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H6550	009	0	1	02	01	H6550_009_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	470.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H6551	001	0	1	20	08	H6551_001_0	3				1																																																																				
H6551	002	0	1	20	08	H6551_002_0	3				1																																																																				
H6566	001	0	1	04	01	H6566_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	01	30		000				1	31	2	2	35.00	70.00	105.00				35.00		35.00	25	25	25				25		25			1	1
H6586	001	0	1	04	01	H6586_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6586	002	0	1	04	01	H6586_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6586	003	0	1	04	01	H6586_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6586	005	0	1	04	01	H6586_005_0	5	N	N		2																																																																				
H6586	006	0	1	04	01	H6586_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6595	003	0	1	02	01	H6595_003_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H6595	004	0	1	02	01	H6595_004_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H6595	005	0	1	02	01	H6595_005_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H6596	001	0	1	20	08	H6596_001_0	5				1																																																																				
H6596	002	0	1	20	08	H6596_002_0	5				1																																																																				
H6622	001	0	1	01	01	H6622_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	004	0	1	01	01	H6622_004_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	007	0	1	01	01	H6622_007_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	008	0	1	01	01	H6622_008_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	013	0	1	02	01	H6622_013_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	014	0	1	02	01	H6622_014_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	015	0	1	01	01	H6622_015_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	017	0	1	01	01	H6622_017_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	340.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H6622	018	0	1	01	01	H6622_018_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	021	1	1	02	01	H6622_021_1	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	021	2	1	02	01	H6622_021_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	022	0	1	02	01	H6622_022_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	023	0	1	02	01	H6622_023_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	500.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	025	0	1	02	01	H6622_025_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	026	0	1	02	01	H6622_026_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	027	0	1	02	01	H6622_027_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	028	0	1	01	01	H6622_028_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	029	0	1	01	01	H6622_029_0	3			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H6622	032	0	1	01	01	H6622_032_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	033	0	1	01	01	H6622_033_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	035	0	1	01	01	H6622_035_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	036	0	1	01	01	H6622_036_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	037	0	1	01	01	H6622_037_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	047	0	1	01	01	H6622_047_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	048	0	1	01	01	H6622_048_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	054	0	1	01	01	H6622_054_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	055	0	1	01	01	H6622_055_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	056	0	1	01	01	H6622_056_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	057	0	1	02	01	H6622_057_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	060	0	1	02	01	H6622_060_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	061	0	1	02	01	H6622_061_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	071	0	1	01	01	H6622_071_0	2			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H6622	075	0	1	01	01	H6622_075_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	078	1	1	01	01	H6622_078_1	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	078	2	1	01	01	H6622_078_2	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	079	0	1	01	01	H6622_079_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	385.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H6622	081	0	1	01	01	H6622_081_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	082	0	1	01	01	H6622_082_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	083	0	1	01	01	H6622_083_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	084	0	1	01	01	H6622_084_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H6622	085	0	1	01	01	H6622_085_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	087	0	1	01	01	H6622_087_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H6622	090	0	1	01	01	H6622_090_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	091	0	1	01	01	H6622_091_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	094	0	1	01	01	H6622_094_0	2	N	N		2																																																																				
H6622	095	0	1	01	01	H6622_095_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	097	0	1	01	01	H6622_097_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H6622	098	0	1	01	01	H6622_098_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0110001	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H6622	099	1	1	01	01	H6622_099_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	099	2	1	01	01	H6622_099_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	100	1	1	01	01	H6622_100_1	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	100	2	1	01	01	H6622_100_2	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H6622	101	0	1	01	01	H6622_101_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	265.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H6622	801	0	1	01	01	H6622_801_0	5				1																																																																				
H6622	802	0	1	01	01	H6622_802_0	5	N	N		2																																																																				
H6622	804	0	1	01	01	H6622_804_0	5				1																																																																				
H6622	805	0	1	01	01	H6622_805_0	5	N	N		2																																																																				
H6652	001	0	1	01	01	H6652_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H6672	003	0	1	01	01	H6672_003_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H6672	005	0	1	01	01	H6672_005_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	011		2	3		0001110	1																																		1		1	1
H6706	001	0	1	02	01	H6706_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H6723	001	1	1	01	01	H6723_001_1	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	001	3	1	01	01	H6723_001_3	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	002	1	1	01	01	H6723_002_1	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	002	3	1	01	01	H6723_002_3	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	003	1	1	01	01	H6723_003_1	14			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	003	3	1	01	01	H6723_003_3	16			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	55.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	006	6	1	02	01	H6723_006_6	15			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	006	7	1	02	01	H6723_006_7	5			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	We offer lower cost share than CMS standards.	2	3		0001100	1																																		1		1	1
H6723	801	0	1	01	01	H6723_801_0	9				1																																																																				
H6723	802	0	1	01	01	H6723_802_0	9				1																																																																				
H6723	803	0	1	01	01	H6723_803_0	9	N	N		2																																																																				
H6743	001	0	1	04	01	H6743_001_0	7			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H6743	007	0	1	04	01	H6743_007_0	10			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H6743	025	0	1	04	01	H6743_025_0	7			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H6743	026	0	1	04	01	H6743_026_0	9			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		1	3		0011100	1																																				1	1
H6743	027	0	1	04	01	H6743_027_0	5	N	N		2																																																																				
H6743	028	0	1	04	01	H6743_028_0	9			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H6743	029	0	1	04	01	H6743_029_0	5	N	N		2																																																																				
H6743	030	0	1	04	01	H6743_030_0	8			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		1	3		0011100	1																																				1	1
H6743	031	0	1	04	01	H6743_031_0	5	N	N		2																																																																				
H6743	801	0	1	04	01	H6743_801_0	4				1																																																																				
H6743	802	0	1	04	01	H6743_802_0	4				1																																																																				
H6743	803	0	1	04	01	H6743_803_0	4	N	N		2																																																																				
H6743	804	0	1	04	01	H6743_804_0	4	N	N		2																																																																				
H6759	001	0	1	20	08	H6759_001_0	2				1																																																																				
H6759	002	0	1	20	08	H6759_002_0	2				1																																																																				
H6765	001	0	1	01	01	H6765_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H6765	002	0	1	01	01	H6765_002_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H6776	001	0	1	01	01	H6776_001_0	5				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H6776	002	0	1	01	01	H6776_002_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H6787	001	0	1	20	08	H6787_001_0	2				1																																																																				
H6787	002	0	1	20	08	H6787_002_0	2				1																																																																				
H6813	001	0	1	04	01	H6813_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6813	006	0	1	04	01	H6813_006_0	4	N	N		2																																																																				
H6815	038	0	1	02	01	H6815_038_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6815	039	0	1	02	01	H6815_039_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6815	040	0	1	02	01	H6815_040_0	6			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H6824	001	0	1	04	01	H6824_001_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H6824	002	0	1	04	01	H6824_002_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H6832	001	0	1	01	01	H6832_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H6832	004	0	1	02	01	H6832_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	The plan has lowered the deductible to $0 for tiers 1 & 2, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H6846	001	0	1	20	08	H6846_001_0	2				1																																																																				
H6846	002	0	1	20	08	H6846_002_0	2				1																																																																				
H6847	001	0	1	02	01	H6847_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H6847	801	0	1	02	01	H6847_801_0	1				1																																																																				
H6847	802	0	1	02	01	H6847_802_0	1	N	N		2																																																																				
H6847	803	0	1	02	01	H6847_803_0	1	N	N		2																																																																				
H6851	001	0	1	01	01	H6851_001_0	8				1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	1	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H6851	002	0	1	01	01	H6851_002_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	495.00	2	0110000	1				1	1	011		2	3		0111100	1																																				1	1
H6851	003	0	1	01	01	H6851_003_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	495.00	2	0110000	1				1	1	011		2	3		0111100	1																																				1	1
H6852	005	0	1	01	01	H6852_005_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H6852	007	0	1	01	01	H6852_007_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H6852	008	0	1	01	01	H6852_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	009	0	1	01	01	H6852_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	010	0	1	01	01	H6852_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	011	0	1	01	01	H6852_011_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	012	0	1	01	01	H6852_012_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	013	0	1	01	01	H6852_013_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	014	0	1	01	01	H6852_014_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	015	0	1	01	01	H6852_015_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	016	0	1	01	01	H6852_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	017	0	1	01	01	H6852_017_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	018	0	1	01	01	H6852_018_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	019	0	1	01	01	H6852_019_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	020	0	1	01	01	H6852_020_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	021	0	1	01	01	H6852_021_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	022	0	1	01	01	H6852_022_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6852	023	0	1	01	01	H6852_023_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6852	025	0	1	01	01	H6852_025_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H6852	026	0	1	01	01	H6852_026_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H6868	001	0	1	20	08	H6868_001_0	2				1																																																																				
H6868	002	0	1	20	08	H6868_002_0	2				1																																																																				
H6874	001	0	1	04	01	H6874_001_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				3	1	111	Reduced deductibles, deductible cost sharing tier exclusions [if deductible is not equal to 0], reduced cost sharing in the Initial Coverage Phase.	2	3		0001100	1																																		1		1	1
H6874	003	0	1	04	01	H6874_003_0	8	N	N		2																																																																				
H6876	001	0	1	04	01	H6876_001_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H6876	003	0	1	04	01	H6876_003_0	9			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H6876	004	0	1	04	01	H6876_004_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H6876	005	0	1	04	01	H6876_005_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H6876	007	0	1	04	01	H6876_007_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	010		1	3		0101111	1																																		1		1	1
H6876	009	0	1	04	01	H6876_009_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0101110	1																																		1		1	1
H6887	001	0	1	20	08	H6887_001_0	3				1																																																																				
H6887	002	0	1	20	08	H6887_002_0	3				1																																																																				
H6891	001	0	1	01	01	H6891_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H6898	801	0	1	04	01	H6898_801_0	4				1																																																																				
H6898	802	0	1	04	01	H6898_802_0	4				1																																																																				
H6898	803	0	1	04	01	H6898_803_0	4				1																																																																				
H6898	804	0	1	04	01	H6898_804_0	4	N	N		2																																																																				
H6898	805	0	2	04	01	H6898_805_0	4				1																																																																				
H6910	001	0	1	01	01	H6910_001_0	6			5F	1	4	101110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	225.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6910	004	0	1	01	01	H6910_004_0	4	N	N		2																																																																				
H6910	005	0	1	01	01	H6910_005_0	6			5F	1	4	101110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6910	801	0	1	01	01	H6910_801_0	1				1																																																																				
H6910	802	0	1	01	01	H6910_802_0	1				1																																																																				
H6941	001	0	1	20	08	H6941_001_0	2				1																																																																				
H6941	002	0	1	20	08	H6941_002_0	2				1																																																																				
H6959	001	0	1	01	01	H6959_001_0	6				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H6959	002	0	1	01	01	H6959_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0100000	1				3	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001100	1																																				1	1
H6971	001	0	1	01	01	H6971_001_0	7		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H6988	004	0	1	01	01	H6988_004_0	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H6988	006	0	1	02	01	H6988_006_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H6988	007	0	1	02	01	H6988_007_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H6988	008	0	1	02	01	H6988_008_0	4	N	N		2																																																																				
H6988	009	0	1	02	01	H6988_009_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	240.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H6988	010	0	1	02	01	H6988_010_0	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	230.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H6994	001	0	1	01	01	H6994_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	330.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	002	0	1	01	01	H6994_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	003	0	1	01	01	H6994_003_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6994	004	0	1	01	01	H6994_004_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6994	008	0	1	01	01	H6994_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	009	0	1	01	01	H6994_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	010	0	1	01	01	H6994_010_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H6994	011	0	1	01	01	H6994_011_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	330.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	012	0	1	01	01	H6994_012_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H6994	013	0	1	01	01	H6994_013_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7003	001	0	1	20	08	H7003_001_0	2				1																																																																				
H7003	002	0	1	20	08	H7003_002_0	2				1																																																																				
H7006	007	0	1	04	01	H7006_007_0	7			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H7006	018	0	1	04	01	H7006_018_0	10			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	011		1	3		0011100	1																																				1	1
H7006	021	0	1	04	01	H7006_021_0	5	N	N		2																																																																				
H7006	022	0	1	04	01	H7006_022_0	10			5F4	1	4	110110	1	2	1	1	6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	010		1	3		0011100	1																																				1	1
H7020	005	0	1	01	01	H7020_005_0	3	N	N		2																																																																				
H7020	010	1	1	01	01	H7020_010_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	010	2	1	01	01	H7020_010_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	010	3	1	01	01	H7020_010_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	011	1	1	01	01	H7020_011_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	011	2	1	01	01	H7020_011_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	011	3	1	01	01	H7020_011_3	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7020	801	0	1	01	01	H7020_801_0	2				1																																																																				
H7027	001	0	1	20	08	H7027_001_0	3				1																																																																				
H7027	002	0	1	20	08	H7027_002_0	3				1																																																																				
H7028	001	0	1	04	01	H7028_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7028	002	0	1	04	01	H7028_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7028	003	0	1	04	01	H7028_003_0	4	N	N		2																																																																				
H7028	004	0	1	04	01	H7028_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	390.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7028	005	0	1	04	01	H7028_005_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7028	006	0	1	04	01	H7028_006_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7059	001	0	1	20	08	H7059_001_0	2				1																																																																				
H7059	002	0	1	20	08	H7059_002_0	2				1																																																																				
H7063	001	0	1	04	01	H7063_001_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	011		1	3		0111100	3																																		1		1	1
H7063	006	0	1	04	01	H7063_006_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	011		1	3		0111100	3																																		1		1	1
H7063	007	0	1	04	01	H7063_007_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	011		1	3		0111100	3																																		1		1	1
H7063	012	0	1	04	01	H7063_012_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	011		1	3		0111100	3																																		1		1	1
H7063	013	0	1	04	01	H7063_013_0	2	N	N		2																																																																				
H7063	801	0	1	04	01	H7063_801_0	1				1																																																																				
H7063	802	0	1	04	01	H7063_802_0	1				1																																																																				
H7074	001	0	1	04	01	H7074_001_0	8			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H7074	801	0	1	04	01	H7074_801_0	1				1																																																																				
H7074	802	0	1	04	01	H7074_802_0	1				1																																																																				
H7074	803	0	1	04	01	H7074_803_0	1	N	N		2																																																																				
H7074	804	0	1	04	01	H7074_804_0	1	N	N		2																																																																				
H7093	001	0	1	04	01	H7093_001_0	4	N	N		2																																																																				
H7093	002	0	1	04	01	H7093_002_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	95.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H7114	001	0	1	20	08	H7114_001_0	2				1																																																																				
H7114	002	0	1	20	08	H7114_002_0	2				1																																																																				
H7115	001	0	1	01	01	H7115_001_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of the following benefit enhancements relative to defined standard: reduced ICL cost sharing, a reduced deductible, or reduced insulin cost sharing	2	3		0111100	1																																		1		1	1
H7115	005	0	1	01	01	H7115_005_0	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		110	30		90	1	31	2	2	35.00	70.00	105.00	35.00		105.00	35.00		35.00	25	25	25	25		25	25		25			1	1
H7115	006	0	1	01	01	H7115_006_0	7	N	N		2																																																																				
H7115	805	0	1	01	01	H7115_805_0	5				1																																																																				
H7115	806	0	1	01	01	H7115_806_0	5				1																																																																				
H7115	807	0	1	01	01	H7115_807_0	5	N	N		2																																																																				
H7123	001	0	1	01	01	H7123_001_0	17		N	5F	1	2	110110	1		1	1	5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1	1	1	1
H7147	001	0	1	01	01	H7147_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7147	003	0	1	01	01	H7147_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7147	004	0	1	01	01	H7147_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7147	007	0	1	01	01	H7147_007_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7147	009	0	1	01	01	H7147_009_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7147	010	0	1	01	01	H7147_010_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7147	011	0	1	01	01	H7147_011_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7147	012	0	1	01	01	H7147_012_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7147	013	0	1	01	01	H7147_013_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7149	001	0	1	02	01	H7149_001_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7149	006	0	1	01	01	H7149_006_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H7149	007	0	1	02	01	H7149_007_0	2	N	N		2																																																																				
H7149	801	0	1	01	01	H7149_801_0	1	N	N		2																																																																				
H7151	001	0	1	01	01	H7151_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7151	003	0	1	01	01	H7151_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7151	005	0	1	01	01	H7151_005_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7151	006	0	1	01	01	H7151_006_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7195	001	0	1	20	08	H7195_001_0	2				1																																																																				
H7195	002	0	1	20	08	H7195_002_0	2				1																																																																				
H7199	002	0	1	04	01	H7199_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7220	004	0	1	02	01	H7220_004_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H7220	009	1	1	01	01	H7220_009_1	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H7220	009	2	1	01	01	H7220_009_2	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H7220	010	0	1	01	01	H7220_010_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H7233	001	0	1	20	08	H7233_001_0	2				1																																																																				
H7233	002	0	1	20	08	H7233_002_0	2				1																																																																				
H7239	001	0	1	01	01	H7239_001_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7239	002	0	1	01	01	H7239_002_0	7		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1	1	1	1
H7239	003	0	1	01	01	H7239_003_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT)	1	3		0011010	1																																		1		1	1
H7239	004	0	1	01	01	H7239_004_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7239	005	0	1	01	01	H7239_005_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0111001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7262	001	0	1	20	08	H7262_001_0	2				1																																																																				
H7262	002	0	1	20	08	H7262_002_0	2				1																																																																				
H7275	001	0	1	01	01	H7275_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7284	001	0	1	04	01	H7284_001_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7284	008	0	1	04	01	H7284_008_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7284	009	0	1	04	01	H7284_009_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7284	010	0	1	04	01	H7284_010_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7296	001	0	1	20	08	H7296_001_0	2				1																																																																				
H7296	002	0	1	20	08	H7296_002_0	2				1																																																																				
H7301	002	0	1	04	01	H7301_002_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	006	0	1	04	01	H7301_006_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	007	0	1	04	01	H7301_007_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	009	0	1	04	01	H7301_009_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	013	0	1	04	01	H7301_013_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	021	0	1	04	01	H7301_021_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	023	0	1	04	01	H7301_023_0	2	N	N		2																																																																				
H7301	027	0	1	04	01	H7301_027_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	032	0	1	04	01	H7301_032_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	033	0	1	04	01	H7301_033_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	034	0	1	04	01	H7301_034_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H7301	803	0	1	04	01	H7301_803_0	1	N	N		2																																																																				
H7323	007	0	1	04	01	H7323_007_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H7323	012	0	1	04	01	H7323_012_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H7326	001	0	1	04	01	H7326_001_0	9			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H7326	007	0	1	04	01	H7326_007_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H7355	001	0	1	04	01	H7355_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7355	002	0	1	04	01	H7355_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7355	003	0	1	04	01	H7355_003_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7355	004	0	1	04	01	H7355_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7355	006	0	1	04	01	H7355_006_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7355	007	0	1	04	01	H7355_007_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7355	009	0	1	04	01	H7355_009_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7355	010	0	1	04	01	H7355_010_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7366	001	0	1	20	08	H7366_001_0	2				1																																																																				
H7366	002	0	1	20	08	H7366_002_0	2				1																																																																				
H7379	001	0	1	04	01	H7379_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan does not include a deductible and cost-sharing for each tier is reduced lower than the defined standard prescription drug coverage.	2	3		0111110	1																																		1		1	1
H7379	002	0	1	04	01	H7379_002_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	2	3		0111110	1																																		1		1	1
H7379	003	0	1	04	01	H7379_003_0	5	N	N		2																																																																				
H7379	801	0	1	04	01	H7379_801_0	3				1																																																																				
H7379	802	0	1	04	01	H7379_802_0	3	N	N		2																																																																				
H7379	803	0	1	04	01	H7379_803_0	3				1																																																																				
H7379	804	0	1	04	01	H7379_804_0	3	N	N		2																																																																				
H7389	801	0	1	01	01	H7389_801_0	1				1																																																																				
H7397	001	0	1	04	01	H7397_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7397	002	0	1	04	01	H7397_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7397	003	0	1	04	01	H7397_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7397	004	0	1	04	01	H7397_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7397	006	0	1	04	01	H7397_006_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7397	007	0	1	04	01	H7397_007_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7397	009	0	1	04	01	H7397_009_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7397	010	0	1	04	01	H7397_010_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7435	001	0	1	01	01	H7435_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0000001	1				2					3		0001100	1																																		1	1	1	1
H7464	008	1	1	01	01	H7464_008_1	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H7464	008	2	1	01	01	H7464_008_2	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
H7464	010	0	1	01	01	H7464_010_0	4		N		1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H7464	012	0	1	02	01	H7464_012_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 .	2	3		0001110	1																																		1	1	1	1
H7469	001	0	1	20	08	H7469_001_0	2				1																																																																				
H7469	002	0	1	20	08	H7469_002_0	2				1																																																																				
H7471	001	0	1	04	01	H7471_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	002	0	1	04	01	H7471_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	004	0	1	04	01	H7471_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	005	0	1	04	01	H7471_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	006	0	1	04	01	H7471_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	007	0	1	04	01	H7471_007_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	008	0	1	04	01	H7471_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	009	0	1	04	01	H7471_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	011	0	1	04	01	H7471_011_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	012	0	1	04	01	H7471_012_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7471	013	0	1	04	01	H7471_013_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7471	014	0	1	04	01	H7471_014_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7471	015	0	1	04	01	H7471_015_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7471	016	0	1	04	01	H7471_016_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7471	017	0	1	04	01	H7471_017_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7501	001	0	1	20	08	H7501_001_0	2				1																																																																				
H7501	002	0	1	20	08	H7501_002_0	2				1																																																																				
H7511	001	0	1	01	01	H7511_001_0	7				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H7511	002	0	1	01	01	H7511_002_0	6			5F4	1	4	110100	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																				1	1
H7512	801	0	1	04	01	H7512_801_0	3				1																																																																				
H7518	001	0	1	04	01	H7518_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H7518	002	0	1	04	01	H7518_002_0	7	N	N		2																																																																				
H7518	003	0	1	04	01	H7518_003_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	515.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H7522	801	0	1	04	01	H7522_801_0	2				1																																																																				
H7522	802	0	1	04	01	H7522_802_0	2				1																																																																				
H7522	804	0	1	04	01	H7522_804_0	2				1																																																																				
H7522	805	0	1	04	01	H7522_805_0	2				1																																																																				
H7522	806	0	1	04	01	H7522_806_0	2				1																																																																				
H7522	807	0	1	04	01	H7522_807_0	2				1																																																																				
H7522	808	0	1	04	01	H7522_808_0	2				1																																																																				
H7522	809	0	1	04	01	H7522_809_0	2				1																																																																				
H7522	810	0	1	04	01	H7522_810_0	2				1																																																																				
H7522	811	0	1	04	01	H7522_811_0	2				1																																																																				
H7522	812	0	1	04	01	H7522_812_0	2				1																																																																				
H7522	813	0	1	04	01	H7522_813_0	2				1																																																																				
H7522	814	0	1	04	01	H7522_814_0	2				1																																																																				
H7522	815	0	1	04	01	H7522_815_0	2				1																																																																				
H7524	001	0	1	01	01	H7524_001_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The plan offers $0 copays on preferred generic drugs.	2	3		0111110	1																																		1	1	1	1
H7524	002	0	1	01	01	H7524_002_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The plan offers $0 copays on preferred generic drugs.	2	3		0111110	1																																		1	1	1	1
H7524	003	0	1	01	01	H7524_003_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The plan offers $0 copays on preferred generic drugs.	2	3		0111110	1																																		1	1	1	1
H7524	004	0	1	01	01	H7524_004_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2	1	100	The plan offers $0 copays on preferred generic drugs.	2	3		0111110	1																																		1	1	1	1
H7557	001	0	1	01	01	H7557_001_0	6				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H7598	003	0	1	01	01	H7598_003_0	5		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7598	004	0	1	01	01	H7598_004_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for scripts on tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H7605	001	0	1	01	01	H7605_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	002	0	1	01	01	H7605_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	004	0	1	01	01	H7605_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	005	0	1	01	01	H7605_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	007	0	1	01	01	H7605_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	008	0	1	01	01	H7605_008_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	009	0	1	01	01	H7605_009_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	010	0	1	01	01	H7605_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7605	016	0	1	01	01	H7605_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7607	014	0	1	01	01	H7607_014_0	12			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The value of the plan is optimized because of the elimination of annual deductible ( Phase 1). Plus, in Phase 2 (initial coverage) we eliminated the copay amount for Tier 1 and Tier 2 drugs and are charging a low copay for Tier 3 drugs. The out-of-pocket cost for the member is below the standard 25% cost-sharing amount in the initial coverage phase.	1	3		0001110	1																																				1	1
H7607	015	0	1	01	01	H7607_015_0	12			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	The value of the plan is optimized because of the elimination of annual deductible (Phase 1). Plus, in Phase 2 (initial coverage) we eliminated the copay amount for Tier 1 and Tier 2 drugs. We are charging a low copay for Tier 3 and Tier 4 drugs. The out-of-pocket cost for the member is below the standard 25% cost-sharing amount in the initial coverage phase.	1	3		0001110	1																																				1	1
H7607	016	0	1	01	01	H7607_016_0	11			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The value of the plan is optimized because we reduced the coinsurance on Tier 1 and Tier 6 to $0, reduced the coinsurance on Tier 2 to 10%, and waived the deductible on Tiers 1, 2 and 6.	1	3		0001110	1																																		1		1	1
H7607	017	0	1	01	01	H7607_017_0	11			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	We reduced the coinsurance on Tier 6 to $0 and waived the deductible on Tier 6.	1	3		0001110	1																																		1		1	1
H7617	003	0	1	04	01	H7617_003_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	004	0	1	04	01	H7617_004_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	005	0	1	04	01	H7617_005_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	006	0	1	04	01	H7617_006_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H7617	007	0	1	04	01	H7617_007_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	008	0	1	04	01	H7617_008_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	009	0	1	04	01	H7617_009_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	010	0	1	04	01	H7617_010_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	011	0	1	04	01	H7617_011_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	012	0	1	04	01	H7617_012_0	2	N	N		2																																																																				
H7617	013	0	1	04	01	H7617_013_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	014	0	1	04	01	H7617_014_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	015	0	1	04	01	H7617_015_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	016	0	1	04	01	H7617_016_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	017	0	1	04	01	H7617_017_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	018	0	1	04	01	H7617_018_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	019	0	1	04	01	H7617_019_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	020	0	1	04	01	H7617_020_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	021	0	1	04	01	H7617_021_0	2	N	N		2																																																																				
H7617	022	0	1	04	01	H7617_022_0	2	N	N		2																																																																				
H7617	023	0	1	04	01	H7617_023_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	024	0	1	04	01	H7617_024_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	025	0	1	04	01	H7617_025_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	026	0	1	04	01	H7617_026_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	027	0	1	04	01	H7617_027_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	028	0	1	04	01	H7617_028_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	029	0	1	04	01	H7617_029_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	030	0	1	04	01	H7617_030_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	031	0	1	04	01	H7617_031_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	032	0	1	04	01	H7617_032_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	033	0	1	04	01	H7617_033_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H7617	034	0	1	04	01	H7617_034_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111111	1																																		1		1	1
H7617	035	0	1	04	01	H7617_035_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	036	0	1	04	01	H7617_036_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	037	0	1	04	01	H7617_037_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	038	0	1	04	01	H7617_038_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	039	0	1	04	01	H7617_039_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	040	0	1	04	01	H7617_040_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	041	0	1	04	01	H7617_041_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	042	0	1	04	01	H7617_042_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	043	0	1	04	01	H7617_043_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	044	0	1	04	01	H7617_044_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	045	0	1	04	01	H7617_045_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	360.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	046	0	1	04	01	H7617_046_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	048	0	1	04	01	H7617_048_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	049	0	1	04	01	H7617_049_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	050	0	1	04	01	H7617_050_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	051	0	1	04	01	H7617_051_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	052	0	1	04	01	H7617_052_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	053	0	1	04	01	H7617_053_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	054	0	1	04	01	H7617_054_0	2	N	N		2																																																																				
H7617	055	0	1	04	01	H7617_055_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	056	0	1	04	01	H7617_056_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	057	0	1	04	01	H7617_057_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	058	0	1	04	01	H7617_058_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	059	0	1	04	01	H7617_059_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	060	0	1	04	01	H7617_060_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	061	0	1	04	01	H7617_061_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	062	0	1	04	01	H7617_062_0	1	N	N		2																																																																				
H7617	063	0	1	04	01	H7617_063_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	340.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	064	0	1	04	01	H7617_064_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	065	0	1	04	01	H7617_065_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	066	0	1	04	01	H7617_066_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	420.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	067	0	1	04	01	H7617_067_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1	1	1	1
H7617	068	0	1	04	01	H7617_068_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	069	0	1	04	01	H7617_069_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	070	0	1	04	01	H7617_070_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	071	0	1	04	01	H7617_071_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	072	0	1	04	01	H7617_072_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	073	0	1	04	01	H7617_073_0	2	N	N		2																																																																				
H7617	074	0	1	04	01	H7617_074_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	075	0	1	04	01	H7617_075_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	076	0	1	04	01	H7617_076_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	077	0	1	04	01	H7617_077_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H7617	078	0	1	04	01	H7617_078_0	4			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H7617	079	0	1	04	01	H7617_079_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	080	0	1	04	01	H7617_080_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	081	0	1	04	01	H7617_081_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H7617	082	0	1	04	01	H7617_082_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	083	0	1	04	01	H7617_083_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	084	0	1	04	01	H7617_084_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	085	0	1	04	01	H7617_085_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	086	0	1	04	01	H7617_086_0	1	N	N		2																																																																				
H7617	087	0	1	04	01	H7617_087_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H7617	088	0	1	04	01	H7617_088_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H7617	089	0	1	04	01	H7617_089_0	5				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
H7617	090	0	1	04	01	H7617_090_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	091	0	1	04	01	H7617_091_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	092	0	1	04	01	H7617_092_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	093	0	1	04	01	H7617_093_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	094	0	1	04	01	H7617_094_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	095	0	1	04	01	H7617_095_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	096	0	1	04	01	H7617_096_0	1	N	N		2																																																																				
H7617	098	0	1	04	01	H7617_098_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	100	0	1	04	01	H7617_100_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	360.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H7617	101	0	1	04	01	H7617_101_0	1	N	N		2																																																																				
H7617	107	0	1	04	01	H7617_107_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	108	0	1	04	01	H7617_108_0	2	N	N		2																																																																				
H7617	109	0	1	04	01	H7617_109_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	110	0	1	04	01	H7617_110_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	111	0	1	04	01	H7617_111_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	112	0	1	04	01	H7617_112_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H7617	113	0	1	04	01	H7617_113_0	4		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H7617	801	0	1	04	01	H7617_801_0	3				1																																																																				
H7617	802	0	1	04	01	H7617_802_0	2	N	N		2																																																																				
H7617	803	0	2	04	01	H7617_803_0	2				1																																																																				
H7617	804	0	2	04	01	H7617_804_0	2	N	N		2																																																																				
H7617	805	0	1	04	01	H7617_805_0	2				1																																																																				
H7617	806	0	1	04	01	H7617_806_0	2	N	N		2																																																																				
H7617	807	0	1	04	01	H7617_807_0	2				1																																																																				
H7617	808	0	1	04	01	H7617_808_0	2	N	N		2																																																																				
H7617	811	0	1	04	01	H7617_811_0	2				1																																																																				
H7617	812	0	1	04	01	H7617_812_0	2	N	N		2																																																																				
H7617	817	0	1	04	01	H7617_817_0	2				1																																																																				
H7617	818	0	1	04	01	H7617_818_0	2	N	N		2																																																																				
H7619	001	0	1	20	08	H7619_001_0	2				1																																																																				
H7619	002	0	1	20	08	H7619_002_0	2				1																																																																				
H7620	001	0	1	01	01	H7620_001_0	10		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				4	1	101	Part D Benefit includes reduced cost sharing by way of, copay and deductible. Reduced copay and deductible waived for select tiers.	2	3		0111111	1																																		1	1	1	1
H7635	001	0	1	01	01	H7635_001_0	12		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	Neighborhood Health Plan is increasing the actuarial value of benefits through the elimination of the Part D deductible, coverage of Tier One and Tier Two drugs/supplies at $0 for both 30-day supply and 90-day supply.	2	3		0111110	1																																		1	1	1	1
H7656	001	0	1	20	08	H7656_001_0	2				1																																																																				
H7656	002	0	1	20	08	H7656_002_0	2				1																																																																				
H7660	001	0	1	20	08	H7660_001_0	2				1																																																																				
H7660	002	0	1	20	08	H7660_002_0	2				1																																																																				
H7670	001	0	1	01	01	H7670_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	No cost sharing on tiers 1 and 2.	1	3		0001100	1																																		1		1	1
H7670	002	0	1	01	01	H7670_002_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	No cost sharing on tiers 1 and 2.	1	3		0001100	1																																		1		1	1
H7678	006	1	1	01	01	H7678_006_1	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H7678	006	2	1	01	01	H7678_006_2	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1, 2 and 6.	2	3		0001110	1																																		1	1	1	1
H7680	001	0	1	01	01	H7680_001_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7680	002	0	1	01	01	H7680_002_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible,. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7680	007	0	1	01	01	H7680_007_0	5		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1	1	1	1
H7680	009	0	1	01	01	H7680_009_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7680	011	0	1	01	01	H7680_011_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7680	012	0	1	01	01	H7680_012_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7680	014	0	1	01	01	H7680_014_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7680	015	0	1	01	01	H7680_015_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7680	016	0	1	01	01	H7680_016_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	100.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7680	017	0	1	01	01	H7680_017_0	5		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1	1	1	1
H7680	018	0	1	01	01	H7680_018_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT)	1	3		0011010	1																																		1		1	1
H7680	019	0	1	02	01	H7680_019_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																				1	1
H7680	020	0	1	01	01	H7680_020_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	1	3		0011010	1																																		1		1	1
H7680	801	0	1	01	01	H7680_801_0	1	N	N		2																																																																				
H7710	001	0	1	01	01	H7710_001_0	5		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7710	002	0	1	01	01	H7710_002_0	5		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7725	001	0	1	20	08	H7725_001_0	2				1																																																																				
H7725	002	0	1	20	08	H7725_002_0	2				1																																																																				
H7766	001	0	1	04	01	H7766_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7766	002	0	1	04	01	H7766_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7766	004	0	1	04	01	H7766_004_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7766	005	0	1	04	01	H7766_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7766	006	0	1	04	01	H7766_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7766	012	0	1	04	01	H7766_012_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7766	013	0	1	04	01	H7766_013_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7766	014	0	1	04	01	H7766_014_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7766	015	0	1	04	01	H7766_015_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7777	001	0	1	20	08	H7777_001_0	2				1																																																																				
H7777	002	0	1	20	08	H7777_002_0	1				1																																																																				
H7779	001	0	1	01	01	H7779_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7787	001	0	1	04	01	H7787_001_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7787	801	0	1	04	01	H7787_801_0	1				1																																																																				
H7787	802	0	1	04	01	H7787_802_0	1	N	N		2																																																																				
H7787	803	0	1	04	01	H7787_803_0	1	N	N		2																																																																				
H7787	804	0	1	04	01	H7787_804_0	1				1																																																																				
H7787	805	0	1	04	01	H7787_805_0	1	N	N		2																																																																				
H7787	806	0	1	04	01	H7787_806_0	1	N	N		2																																																																				
H7787	807	0	1	04	01	H7787_807_0	1				1																																																																				
H7787	808	0	1	04	01	H7787_808_0	1	N	N		2																																																																				
H7787	809	0	1	04	01	H7787_809_0	1	N	N		2																																																																				
H7787	810	0	1	04	01	H7787_810_0	1				1																																																																				
H7787	811	0	1	04	01	H7787_811_0	1	N	N		2																																																																				
H7787	812	0	1	04	01	H7787_812_0	1	N	N		2																																																																				
H7787	813	0	1	04	01	H7787_813_0	1				1																																																																				
H7787	814	0	1	04	01	H7787_814_0	1	N	N		2																																																																				
H7787	815	0	1	04	01	H7787_815_0	1	N	N		2																																																																				
H7787	816	0	1	04	01	H7787_816_0	1				1																																																																				
H7787	817	0	1	04	01	H7787_817_0	1				1																																																																				
H7787	818	0	1	04	01	H7787_818_0	1				1																																																																				
H7787	819	0	1	04	01	H7787_819_0	1				1																																																																				
H7787	820	0	1	04	01	H7787_820_0	1				1																																																																				
H7787	821	0	1	04	01	H7787_821_0	1				1																																																																				
H7787	822	0	1	04	01	H7787_822_0	1				1																																																																				
H7787	823	0	1	04	01	H7787_823_0	1	N	N		2																																																																				
H7787	824	0	1	04	01	H7787_824_0	1	N	N		2																																																																				
H7787	825	0	1	04	01	H7787_825_0	1				1																																																																				
H7787	826	0	1	04	01	H7787_826_0	1				1																																																																				
H7787	827	0	1	04	01	H7787_827_0	1	N	N		2																																																																				
H7813	001	0	1	01	01	H7813_001_0	3		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H7831	001	0	1	20	08	H7831_001_0	2				1																																																																				
H7831	002	0	1	20	08	H7831_002_0	2				1																																																																				
H7849	002	0	1	04	01	H7849_002_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	015	0	1	04	01	H7849_015_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	024	0	1	04	01	H7849_024_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	029	0	1	04	01	H7849_029_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	059	0	1	04	01	H7849_059_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	065	0	1	04	01	H7849_065_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	070	0	1	04	01	H7849_070_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	077	0	1	04	01	H7849_077_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	080	0	1	04	01	H7849_080_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	088	0	1	04	01	H7849_088_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	102	1	1	04	01	H7849_102_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	102	2	1	04	01	H7849_102_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	102	3	1	04	01	H7849_102_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	106	0	1	04	01	H7849_106_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	113	1	1	04	01	H7849_113_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	113	2	1	04	01	H7849_113_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	113	3	1	04	01	H7849_113_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	113	4	1	04	01	H7849_113_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	114	0	1	04	01	H7849_114_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	135	0	1	04	01	H7849_135_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	136	1	1	04	01	H7849_136_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	136	2	1	04	01	H7849_136_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	136	3	1	04	01	H7849_136_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	142	0	1	04	01	H7849_142_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	143	0	1	04	01	H7849_143_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	144	0	1	04	01	H7849_144_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	145	0	1	04	01	H7849_145_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	146	0	1	04	01	H7849_146_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	147	0	1	04	01	H7849_147_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	148	0	1	04	01	H7849_148_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	149	0	1	04	01	H7849_149_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	150	0	1	04	01	H7849_150_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	151	0	1	04	01	H7849_151_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	152	0	1	04	01	H7849_152_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	153	0	1	04	01	H7849_153_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	154	0	1	04	01	H7849_154_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	155	0	1	04	01	H7849_155_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H7849	835	0	1	04	01	H7849_835_0	4				1																																																																				
H7849	836	0	1	04	01	H7849_836_0	4	N	N		2																																																																				
H7855	001	0	1	20	08	H7855_001_0	2				1																																																																				
H7855	002	0	1	20	08	H7855_002_0	2				1																																																																				
H7917	009	0	1	04	01	H7917_009_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	010	0	1	04	01	H7917_010_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	011	0	1	04	01	H7917_011_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	012	0	1	04	01	H7917_012_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	013	0	1	04	01	H7917_013_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	014	0	1	04	01	H7917_014_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	015	0	1	04	01	H7917_015_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	030	0	1	04	01	H7917_030_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	031	0	1	04	01	H7917_031_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	032	0	1	04	01	H7917_032_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	033	0	1	04	01	H7917_033_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	038	0	1	04	01	H7917_038_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	039	0	1	04	01	H7917_039_0	6	N	N		2																																																																				
H7917	040	0	1	04	01	H7917_040_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	041	0	1	04	01	H7917_041_0	8				1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7917	044	0	1	04	01	H7917_044_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	045	0	1	04	01	H7917_045_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The deductible is reduced to $0 for Tiers 1 & 2; $250 for Tiers 3-5 and the Initial Coverage Phase is set a copayments and coinsurance depending on the Tier.	2	3		0001100	1																																		1		1	1
H7917	046	0	1	04	01	H7917_046_0	5				1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H7917	801	0	1	04	01	H7917_801_0	2				1																																																																				
H7917	802	0	1	04	01	H7917_802_0	2				1																																																																				
H7917	803	0	1	04	01	H7917_803_0	2	N	N		2																																																																				
H7980	001	0	1	04	01	H7980_001_0	8			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	495.00	2	0110000	1				1	1	011		2	3		0111100	1																																				1	1
H7993	001	0	1	01	01	H7993_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	240.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	002	0	1	01	01	H7993_002_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	003	0	1	01	01	H7993_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	004	0	1	01	01	H7993_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	006	0	1	01	01	H7993_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	007	0	1	01	01	H7993_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	008	0	1	01	01	H7993_008_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	010	0	1	01	01	H7993_010_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	012	0	1	01	01	H7993_012_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	014	0	1	01	01	H7993_014_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	305.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	015	0	1	01	01	H7993_015_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	017	0	1	01	01	H7993_017_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	019	0	1	01	01	H7993_019_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	220.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	020	0	1	01	01	H7993_020_0	4	N	N		2																																																																				
H7993	021	0	1	01	01	H7993_021_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	023	0	1	01	01	H7993_023_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	024	0	1	01	01	H7993_024_0	5			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	027	0	1	01	01	H7993_027_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	028	0	1	01	01	H7993_028_0	5			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	029	0	1	01	01	H7993_029_0	5			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	030	0	1	01	01	H7993_030_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	031	0	1	01	01	H7993_031_0	5			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	033	0	1	01	01	H7993_033_0	5			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	034	0	1	01	01	H7993_034_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	035	0	1	01	01	H7993_035_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	036	0	1	01	01	H7993_036_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H7993	037	0	1	01	01	H7993_037_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	038	0	1	01	01	H7993_038_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	040	0	1	01	01	H7993_040_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	041	0	1	01	01	H7993_041_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H7993	046	0	1	01	01	H7993_046_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	480.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H7993	048	0	1	01	01	H7993_048_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8003	001	0	1	04	01	H8003_001_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				2	1	111	The plan will offer a lower deductible than the defined standard plan and lower cost shares on several tiers. We waive the deductible on tiers 1, 2, & 6.	2	3		0001110	1																																		1		1	1
H8003	002	0	1	04	01	H8003_002_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				2	1	111	The plan will offer a lower deductible than the defined standard plan and lower cost shares on several tiers. We waive the deductible on tiers 1, 2, & 6.	2	3		0001110	1																																		1		1	1
H8003	003	0	1	04	01	H8003_003_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				2	1	111	The plan will offer a lower deductible than the defined standard plan and lower cost shares on several tiers. We waive the deductible on tiers 1, 2, & 6.	2	3		0001110	1																																		1		1	1
H8003	004	0	1	04	01	H8003_004_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The plan offers lower cost sharing on several tiers and waives the deductible on multiple tiers.	2	3		0001110	1																																		1		1	1
H8003	005	0	1	04	01	H8003_005_0	4			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The plan offers lower cost sharing on several tiers and waives the deductible on multiple tiers.	2	3		0001110	1																																		1		1	1
H8003	006	0	1	04	01	H8003_006_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The plan offers lower cost sharing on several tiers and waives the deductible on multiple tiers.	2	3		0001110	1																																		1		1	1
H8003	007	0	1	04	01	H8003_007_0	4	N	N		2																																																																				
H8003	801	0	1	04	01	H8003_801_0	2				1																																																																				
H8003	802	0	1	04	01	H8003_802_0	2				1																																																																				
H8003	803	0	1	04	01	H8003_803_0	2	N	N		2																																																																				
H8003	804	0	1	04	01	H8003_804_0	2	N	N		2																																																																				
H8010	002	0	1	01	01	H8010_002_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																				1	1
H8010	003	0	1	01	01	H8010_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The Part D BPT contains various tests to ensure that the Part D benefits meet the requirements to be an enhanced alternative plan, which these plans pass.	2	3		0001110	1																																		1		1	1
H8048	001	0	1	20	08	H8048_001_0	1				1																																																																				
H8048	002	0	1	20	08	H8048_002_0	1				1																																																																				
H8051	001	0	1	01	01	H8051_001_0	10		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				4	1	101	Plan has waived the deductible for Tiers 1 & 6, Reduced cost sharing for both Tiers 1 & 6 to $0.	2	3		0111111	1																																		1	1	1	1
H8067	001	0	1	01	01	H8067_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8067	003	0	1	01	01	H8067_003_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8067	004	0	1	01	01	H8067_004_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8082	001	0	1	20	08	H8082_001_0	2				1																																																																				
H8082	002	0	1	20	08	H8082_002_0	2				1																																																																				
H8093	001	0	1	01	01	H8093_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8093	002	0	1	01	01	H8093_002_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8095	801	0	1	01	01	H8095_801_0	1				1																																																																				
H8095	802	0	1	01	01	H8095_802_0	1	N	N		2																																																																				
H8095	807	0	1	02	01	H8095_807_0	1				1																																																																				
H8095	808	0	1	02	01	H8095_808_0	1	N	N		2																																																																				
H8096	001	0	1	20	08	H8096_001_0	2				1																																																																				
H8096	002	0	1	20	08	H8096_002_0	2				1																																																																				
H8099	001	0	1	20	08	H8099_001_0	2				1																																																																				
H8099	002	0	1	20	08	H8099_002_0	2				1																																																																				
H8121	801	0	1	04	01	H8121_801_0	3				1																																																																				
H8133	001	0	1	01	01	H8133_001_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8133	005	0	1	01	01	H8133_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tier 1 and Tier 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8142	001	0	1	02	01	H8142_001_0	11			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $250 for tiers 3/4/5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H8142	002	0	1	02	01	H8142_002_0	11			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3 in the coverage phase.	2	3		0111100	1																																		1		1	1
H8142	003	0	1	02	01	H8142_003_0	11			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The plan has lowered the deductible to $0 for all tiers and reduced cost sharing via copays for tiers 1/2/3 in the coverage phase.	2	3		0111100	1																																		1		1	1
H8142	004	0	1	02	01	H8142_004_0	11	N	N		2																																																																				
H8142	005	0	1	02	01	H8142_005_0	11	N	N		2																																																																				
H8142	006	0	1	02	01	H8142_006_0	11	N	N		2																																																																				
H8142	007	0	1	02	01	H8142_007_0	9			5F	1	4	101110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The plan has lowered the deductible to $0 for tiers 1 & 2, and to $250 for tiers 3, 4 & 5 in the coverage phase.	2	3		0111100	1																																		1		1	1
H8142	008	0	1	02	01	H8142_008_0	9	N	N		2																																																																				
H8142	009	0	1	02	01	H8142_009_0	11				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8142	010	0	1	02	01	H8142_010_0	9				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8142	801	0	1	02	01	H8142_801_0	1				1																																																																				
H8142	802	0	1	02	01	H8142_802_0	1	N	N		2																																																																				
H8142	803	0	1	02	01	H8142_803_0	1				1																																																																				
H8142	804	0	1	02	01	H8142_804_0	1	N	N		2																																																																				
H8145	004	0	1	09	04	H8145_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	006	0	1	09	04	H8145_006_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
H8145	032	0	1	09	04	H8145_032_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	042	0	1	09	04	H8145_042_0	7	N	N		2																																																																				
H8145	052	0	1	09	04	H8145_052_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	055	0	1	09	04	H8145_055_0	2	N	N		2																																																																				
H8145	069	0	1	09	04	H8145_069_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	084	0	1	09	04	H8145_084_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	091	0	1	09	04	H8145_091_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8145	126	0	1	09	04	H8145_126_0	4	N	N		2																																																																				
H8145	163	0	1	09	04	H8145_163_0	2	N	N		2																																																																				
H8166	003	0	1	04	01	H8166_003_0	4	N	N		2																																																																				
H8166	005	0	1	04	01	H8166_005_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H8166	006	0	1	04	01	H8166_006_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
H8166	007	0	1	04	01	H8166_007_0	5				1	1	110110	1		2											615.00																110	31		100	01	31		100			100	1	31	1	2	35.00		105.00			105.00	35.00		35.00	20		20			20	20		20			1	1
H8166	801	0	1	04	01	H8166_801_0	1	N	N		2																																																																				
H8166	802	0	1	04	01	H8166_802_0	1				1																																																																				
H8166	803	0	1	04	01	H8166_803_0	1				1																																																																				
H8166	804	0	1	04	01	H8166_804_0	1				1																																																																				
H8173	001	0	1	01	01	H8173_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	430.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	005	0	1	01	01	H8173_005_0	4	N	N		2																																																																				
H8173	007	0	1	01	01	H8173_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	011	0	1	01	01	H8173_011_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	013	0	1	01	01	H8173_013_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	014	0	1	01	01	H8173_014_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8173	016	0	1	01	01	H8173_016_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	305.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	019	0	1	01	01	H8173_019_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	020	0	1	01	01	H8173_020_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	021	0	1	01	01	H8173_021_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	022	0	1	01	01	H8173_022_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8173	023	0	1	01	01	H8173_023_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8173	024	0	1	01	01	H8173_024_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8173	025	0	1	01	01	H8173_025_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8173	027	0	1	01	01	H8173_027_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8176	004	1	1	01	01	H8176_004_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8176	004	2	1	01	01	H8176_004_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8181	001	0	1	04	01	H8181_001_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				2	1	111	There is no deductible on tiers 1-3 and cost shares have been reduced, including as low as $0 on tiers 1 and 2.	1	3		0111100	1																																				1	1
H8181	002	0	1	04	01	H8181_002_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				2	1	111	There is no deductible on tiers 1 and 2 and cost shares have been reduced, including as low as $0 on tiers 1 and 2.	1	3		0111100	1																																				1	1
H8181	003	0	1	04	01	H8181_003_0	7			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	400.00	2	0111000	1				2	1	111	There is no deductible on tiers 1, 2 and 3 and cost shares have been reduced, including as low as $0 on tiers 1, 2 and 3.	1	3		0111100	1																																				1	1
H8181	801	0	1	04	01	H8181_801_0	5				1																																																																				
H8181	802	0	1	04	01	H8181_802_0	5	N	N		2																																																																				
H8181	803	0	1	04	01	H8181_803_0	5				1																																																																				
H8181	804	0	1	04	01	H8181_804_0	5				1																																																																				
H8189	001	0	1	02	01	H8189_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H8189	007	0	1	02	01	H8189_007_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H8189	008	0	1	02	01	H8189_008_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H8211	001	0	1	04	01	H8211_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8211	005	0	1	04	01	H8211_005_0	3	N	N		2																																																																				
H8211	006	0	1	04	01	H8211_006_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8211	007	0	1	04	01	H8211_007_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8211	009	0	1	04	01	H8211_009_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8211	010	0	1	04	01	H8211_010_0	3	N	N		2																																																																				
H8211	011	0	1	04	01	H8211_011_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8211	012	0	1	04	01	H8211_012_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8212	001	0	1	01	01	H8212_001_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	001		2	3		0011100	1																																		1	1	1	1
H8298	001	0	1	01	01	H8298_001_0	7		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8320	001	0	1	04	01	H8320_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	385.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	002	0	1	04	01	H8320_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	003	0	1	04	01	H8320_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	385.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	004	0	1	04	01	H8320_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	005	0	1	04	01	H8320_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	385.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	006	0	1	04	01	H8320_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8320	011	0	1	04	01	H8320_011_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8320	012	0	1	04	01	H8320_012_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8320	013	0	1	04	01	H8320_013_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8320	014	0	1	04	01	H8320_014_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8330	001	0	1	01	01	H8330_001_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8330	002	0	1	01	01	H8330_002_0	11		N	1	1	4	110110	1	2	2		1	1					Single Tier		2	400.00	1						1	1	010		2	3		0100000	1																																		1		1	1
H8332	004	0	1	01	01	H8332_004_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H8332	801	0	1	01	01	H8332_801_0	1	N	N		2																																																																				
H8379	001	0	1	01	01	H8379_001_0	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0001110	1																																		1	1	1	1
H8379	003	1	1	01	01	H8379_003_1	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0001110	1																																		1	1	1	1
H8379	003	2	1	01	01	H8379_003_2	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0001110	1																																		1	1	1	1
H8379	003	3	1	01	01	H8379_003_3	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0001110	1																																		1	1	1	1
H8379	003	4	1	01	01	H8379_003_4	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	001		2	3		0001110	1																																		1	1	1	1
H8385	001	0	1	04	01	H8385_001_0	6			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H8385	002	0	1	04	01	H8385_002_0	5			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H8385	003	0	1	04	01	H8385_003_0	5			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H8385	004	0	1	04	01	H8385_004_0	5			5F4	1	4	101101	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				1	1	111	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a reduced Part D deductible waived for tiers 1, 2, and 6. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																		1		1	1
H8390	015	0	1	01	01	H8390_015_0	6		N		1	1	110110	1		2											615.00																111	30	60	102	01	30		111	30	60	102	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8390	017	0	1	01	01	H8390_017_0	6		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The plan is reducing cost share on tier 1 and tier 2 drugs to $0	2	3		0001100	1																																		1	1	1	1
H8421	001	0	1	20	08	H8421_001_0	2				1																																																																				
H8421	002	0	1	20	08	H8421_002_0	2				1																																																																				
H8424	001	0	1	20	08	H8424_001_0	2				1																																																																				
H8424	002	0	1	20	08	H8424_002_0	2				1																																																																				
H8432	009	0	1	01	01	H8432_009_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8432	010	0	1	01	01	H8432_010_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8432	011	0	1	01	01	H8432_011_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8432	016	0	1	02	01	H8432_016_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8432	036	0	1	02	01	H8432_036_0	4	N	N		2																																																																				
H8432	040	0	1	02	01	H8432_040_0	7			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8432	041	0	1	01	01	H8432_041_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8432	042	0	1	01	01	H8432_042_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8432	804	0	1	01	01	H8432_804_0	3				1																																																																				
H8432	805	0	1	01	01	H8432_805_0	3	N	N		2																																																																				
H8432	806	0	2	01	01	H8432_806_0	3				1																																																																				
H8432	811	0	2	01	01	H8432_811_0	4	N	N		2																																																																				
H8432	813	0	1	01	01	H8432_813_0	3	N	N		2																																																																				
H8432	816	0	2	01	01	H8432_816_0	3	N	N		2																																																																				
H8457	001	0	1	01	01	H8457_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H8481	001	0	1	04	01	H8481_001_0	6		N	5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				1	1	101	We are offering $0 copayments for Tier 1 and Tier 2, with the deductible waived for both tiers.	2	3		0111110	1																																		1	1	1	1
H8492	001	0	1	01	01	H8492_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8547	001	0	1	01	01	H8547_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8552	028	0	1	04	01	H8552_028_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H8554	001	0	1	01	01	H8554_001_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8554	003	0	1	01	01	H8554_003_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8578	001	0	1	01	01	H8578_001_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0011110	1																																		1		1	1
H8578	003	0	1	01	01	H8578_003_0	4	N	N		2																																																																				
H8578	004	0	1	01	01	H8578_004_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0011110	1																																		1		1	1
H8578	009	0	1	01	01	H8578_009_0	4	N	N		2																																																																				
H8578	012	0	1	01	01	H8578_012_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	490.00	2	0110000	1				1	1	011		1	3		0011110	1																																		1		1	1
H8578	801	0	1	02	01	H8578_801_0	3				1																																																																				
H8578	802	0	1	02	01	H8578_802_0	3	N	N		2																																																																				
H8578	803	0	1	02	01	H8578_803_0	3				1																																																																				
H8597	001	0	1	01	01	H8597_001_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H8597	002	0	1	01	01	H8597_002_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H8597	003	0	1	01	01	H8597_003_0	3		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H8604	011	0	1	04	01	H8604_011_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																				1	1
H8604	014	1	1	04	01	H8604_014_1	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H8604	014	2	1	04	01	H8604_014_2	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H8604	015	0	1	04	01	H8604_015_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	This plan offers a reduced deductible and reduced cost sharing on some tiers.	2	3		0001100	1																																		1		1	1
H8604	801	0	1	04	01	H8604_801_0	3				1																																																																				
H8614	001	0	1	20	08	H8614_001_0	2				1																																																																				
H8614	002	0	1	20	08	H8614_002_0	2				1																																																																				
H8634	003	0	1	04	01	H8634_003_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	004	0	1	04	01	H8634_004_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	008	0	1	04	01	H8634_008_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	009	0	1	04	01	H8634_009_0	7		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8634	010	0	1	04	01	H8634_010_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	012	0	1	04	01	H8634_012_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	018	0	1	04	01	H8634_018_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	019	0	1	04	01	H8634_019_0	6	N	N		2																																																																				
H8634	021	0	1	04	01	H8634_021_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	022	0	1	04	01	H8634_022_0	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	023	0	1	04	01	H8634_023_0	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	024	0	1	04	01	H8634_024_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	025	0	1	04	01	H8634_025_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	026	0	1	04	01	H8634_026_0	6	N	N		2																																																																				
H8634	027	0	1	04	01	H8634_027_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	028	0	1	04	01	H8634_028_0	7	N	N		2																																																																				
H8634	029	0	1	04	01	H8634_029_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	030	0	1	04	01	H8634_030_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	031	0	1	04	01	H8634_031_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	032	0	1	04	01	H8634_032_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	033	0	1	04	01	H8634_033_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H8634	801	0	1	04	01	H8634_801_0	2				1																																																																				
H8634	803	0	1	04	01	H8634_803_0	2				1																																																																				
H8634	805	0	1	04	01	H8634_805_0	2	N	N		2																																																																				
H8634	807	0	1	04	01	H8634_807_0	2				1																																																																				
H8634	809	0	1	04	01	H8634_809_0	2				1																																																																				
H8634	811	0	1	04	01	H8634_811_0	2	N	N		2																																																																				
H8634	813	0	1	04	01	H8634_813_0	2				1																																																																				
H8634	815	0	1	04	01	H8634_815_0	2				1																																																																				
H8634	817	0	1	04	01	H8634_817_0	2	N	N		2																																																																				
H8634	819	0	1	04	01	H8634_819_0	2	N	N		2																																																																				
H8634	820	0	1	04	01	H8634_820_0	2	N	N		2																																																																				
H8634	821	0	1	04	01	H8634_821_0	2	N	N		2																																																																				
H8634	822	0	1	04	01	H8634_822_0	2				1																																																																				
H8634	823	0	1	04	01	H8634_823_0	2				1																																																																				
H8634	824	0	1	04	01	H8634_824_0	2				1																																																																				
H8649	010	0	1	01	01	H8649_010_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tier 1. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H8649	013	0	1	01	01	H8649_013_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H8649	801	0	1	01	01	H8649_801_0	1				1																																																																				
H8649	803	0	1	01	01	H8649_803_0	1	N	N		2																																																																				
H8655	004	0	1	20	08	H8655_004_0	2				1																																																																				
H8655	005	0	1	20	08	H8655_005_0	2				1																																																																				
H8711	801	0	1	04	01	H8711_801_0	3				1																																																																				
H8764	001	0	1	01	01	H8764_001_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	The benefits have been designed with a reduced deductible below the maximum of $615. In addition, the benefit design provides flat copays to reduce cost-sharing (versus a 25% co-insurance for the CMS-defined standard benefit).	2	3		0111111	1																																		1		1	1
H8764	002	0	1	02	01	H8764_002_0	5			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	The benefits have been designed with a reduced deductible below the maximum of $615. In addition, the benefit design provides flat copays to reduce cost-sharing (versus a 25% co-insurance for the CMS-defined standard benefit).	2	3		0111111	1																																		1		1	1
H8764	003	0	1	01	01	H8764_003_0	6			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	The benefits have been designed with a reduced deductible below the maximum of $615. In addition, the benefit design provides flat copays to reduce cost-sharing (versus a 25% co-insurance for the CMS-defined standard benefit).	2	3		0111111	1																																		1		1	1
H8764	004	0	1	01	01	H8764_004_0	7			5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								1	1	110	The benefits have been designed with a reduced deductible below the maximum of $615. In addition, the benefit design provides flat copays to reduce cost-sharing (versus a 25% co-insurance for the CMS-defined standard benefit).	2	3		0111111	1																																		1		1	1
H8764	801	0	1	02	01	H8764_801_0	3				1																																																																				
H8768	005	0	1	04	01	H8768_005_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	007	0	1	04	01	H8768_007_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	008	0	1	04	01	H8768_008_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	009	0	1	04	01	H8768_009_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	010	0	1	04	01	H8768_010_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	011	0	1	04	01	H8768_011_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	013	0	1	04	01	H8768_013_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	016	0	1	04	01	H8768_016_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	017	1	1	04	01	H8768_017_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	017	2	1	04	01	H8768_017_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	018	0	1	04	01	H8768_018_0	3	N	N		2																																																																				
H8768	019	0	1	04	01	H8768_019_0	3	N	N		2																																																																				
H8768	020	0	1	04	01	H8768_020_0	3	N	N		2																																																																				
H8768	021	0	1	04	01	H8768_021_0	3	N	N		2																																																																				
H8768	022	0	1	04	01	H8768_022_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	023	0	1	04	01	H8768_023_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	024	0	1	04	01	H8768_024_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	025	0	1	04	01	H8768_025_0	3	N	N		2																																																																				
H8768	026	0	1	04	01	H8768_026_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	027	0	1	04	01	H8768_027_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	028	0	1	04	01	H8768_028_0	3	N	N		2																																																																				
H8768	030	0	1	04	01	H8768_030_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	031	0	1	04	01	H8768_031_0	3	N	N		2																																																																				
H8768	034	0	1	04	01	H8768_034_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	035	0	1	04	01	H8768_035_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	037	1	1	04	01	H8768_037_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	037	2	1	04	01	H8768_037_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	039	0	1	04	01	H8768_039_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	040	0	1	04	01	H8768_040_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	045	0	1	04	01	H8768_045_0	3	N	N		2																																																																				
H8768	046	0	1	04	01	H8768_046_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	048	0	1	04	01	H8768_048_0	3	N	N		2																																																																				
H8768	055	1	1	04	01	H8768_055_1	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	055	2	1	04	01	H8768_055_2	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	058	0	1	04	01	H8768_058_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	059	0	1	04	01	H8768_059_0	3	N	N		2																																																																				
H8768	061	0	1	04	01	H8768_061_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	062	0	1	04	01	H8768_062_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8768	063	0	1	04	01	H8768_063_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	520.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
H8769	001	0	1	20	08	H8769_001_0	2				1																																																																				
H8769	002	0	1	20	08	H8769_002_0	2				1																																																																				
H8777	001	0	1	20	08	H8777_001_0	2				1																																																																				
H8777	002	0	1	20	08	H8777_002_0	2				1																																																																				
H8794	001	0	1	01	01	H8794_001_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	002	0	1	01	01	H8794_002_0	7		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	006	0	1	01	01	H8794_006_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	007	0	1	01	01	H8794_007_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	009	0	1	01	01	H8794_009_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	010	0	1	01	01	H8794_010_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	011	0	1	01	01	H8794_011_0	7		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																			1	1	1
H8794	016	0	1	01	01	H8794_016_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	017	0	1	01	01	H8794_017_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	018	0	1	01	01	H8794_018_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	019	0	1	01	01	H8794_019_0	5		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	020	0	1	01	01	H8794_020_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	021	0	1	01	01	H8794_021_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	022	0	1	01	01	H8794_022_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	023	0	1	01	01	H8794_023_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	024	0	1	01	01	H8794_024_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8794	025	0	1	01	01	H8794_025_0	6		N	5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0111001	1				1	1	101	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																		1	1	1	1
H8797	001	0	1	01	01	H8797_001_0	6				1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H8797	003	0	1	02	01	H8797_003_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	90.00	2	0110000	1				3	1	111	The plan has lowered the deductible to $0 for medication tiers 1-2 and to $90 for tiers 3-5, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H8797	004	0	1	02	01	H8797_004_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	The plan has lowered the deductible to $0 for all medication tiers, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H8800	001	0	1	20	08	H8800_001_0	2				1																																																																				
H8800	002	0	1	20	08	H8800_002_0	2				1																																																																				
H8811	001	0	1	20	08	H8811_001_0	2				1																																																																				
H8811	002	0	1	20	08	H8811_002_0	2				1																																																																				
H8832	001	0	1	04	01	H8832_001_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H8832	002	0	1	04	01	H8832_002_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H8832	003	0	1	04	01	H8832_003_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H8832	801	0	1	04	01	H8832_801_0	1				1																																																																				
H8832	802	0	1	04	01	H8832_802_0	2				1																																																																				
H8832	803	0	1	04	01	H8832_803_0	1	N	N		2																																																																				
H8832	804	0	1	04	01	H8832_804_0	1	N	N		2																																																																				
H8845	001	0	1	01	01	H8845_001_0	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3 and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8845	004	0	1	01	01	H8845_004_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8845	005	0	1	01	01	H8845_005_0	9		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8845	007	1	1	01	01	H8845_007_1	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8845	007	2	1	01	01	H8845_007_2	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H8849	001	0	1	02	01	H8849_001_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H8849	003	0	1	02	01	H8849_003_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	75.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H8849	005	0	1	02	01	H8849_005_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	75.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001101	1																																		1		1	1
H8849	006	0	1	02	01	H8849_006_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H8849	009	0	1	02	01	H8849_009_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	1																																		1		1	1
H8849	010	1	1	01	01	H8849_010_1	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	010	2	1	01	01	H8849_010_2	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	010	4	1	01	01	H8849_010_4	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	010	5	1	01	01	H8849_010_5	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	011	1	1	01	01	H8849_011_1	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	011	2	1	01	01	H8849_011_2	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	011	3	1	01	01	H8849_011_3	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	011	4	1	01	01	H8849_011_4	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8849	011	5	1	01	01	H8849_011_5	7		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H8854	002	0	1	01	01	H8854_002_0	7		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan offers a $615 deductible for tiers 3, 4, and 5 only, as well as reduced cost sharing compared to the defined standard prescription drug coverage.	2	3		0111110	1																																		1	1	1	1
H8879	001	0	1	02	01	H8879_001_0	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers reduced cost sharing through a $0 deductible plan and low copays at the preferred pharmacy.	2	3		0011100	1																																				1	1
H8889	001	0	1	04	01	H8889_001_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3, Tier 4 and Tier 5 use a coinsurance.	2	3		0001100	1																																		1		1	1
H8889	002	0	1	04	01	H8889_002_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	003	0	1	04	01	H8889_003_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	125.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H8889	004	0	1	04	01	H8889_004_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	435.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	005	0	1	04	01	H8889_005_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	008	0	1	04	01	H8889_008_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 from standard retail and mail-order locations, and drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	009	0	1	04	01	H8889_009_0	5	N	N		2																																																																				
H8889	010	0	1	04	01	H8889_010_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	011	0	1	04	01	H8889_011_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H8889	012	0	1	04	01	H8889_012_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	325.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	013	0	1	04	01	H8889_013_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	240.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H8889	014	0	1	04	01	H8889_014_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	015	0	1	04	01	H8889_015_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H8889	016	0	1	04	01	H8889_016_0	8		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8889	017	0	1	04	01	H8889_017_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure. Drugs on Tier 3 use a reduced coinsurance.	2	3		0001100	1																																		1		1	1
H8889	018	0	1	04	01	H8889_018_0	5			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	355.00	2	0110000	1				2	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing. Drugs on Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H8889	801	0	1	04	01	H8889_801_0	3				1																																																																				
H8894	001	0	1	01	01	H8894_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Charge zero dollar copays on tiers 1 and 6.	2	3		0111111	1																																		1	1	1	1
H8902	002	0	1	01	01	H8902_002_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	2	3		0001100	1																																		1		1	1
H8902	009	0	1	01	01	H8902_009_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
H8902	010	0	1	01	01	H8902_010_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H8902	011	0	1	01	01	H8902_011_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and no Part D deductible.	1	3		0001100	1																																		1		1	1
H8902	801	0	1	01	01	H8902_801_0	4				1																																																																				
H8902	802	0	1	01	01	H8902_802_0	5				1																																																																				
H8902	803	0	1	01	01	H8902_803_0	5	N	N		2																																																																				
H8902	804	0	1	01	01	H8902_804_0	5	N	N		2																																																																				
H8908	001	0	1	02	01	H8908_001_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8908	004	0	1	02	01	H8908_004_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
H8908	005	0	1	01	01	H8908_005_0	5		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	475.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H8908	006	0	1	01	01	H8908_006_0	5			5F4	1	4	110101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111111	1																																		1		1	1
H8908	007	0	1	01	01	H8908_007_0	3		N	5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1	1	1	1
H8908	801	0	1	01	01	H8908_801_0	3				1																																																																				
H8908	802	0	1	01	01	H8908_802_0	3	N	N		2																																																																				
H8908	804	0	1	01	01	H8908_804_0	3				1																																																																				
H8908	805	0	1	01	01	H8908_805_0	3	N	N		2																																																																				
H8917	001	0	1	04	01	H8917_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8917	002	0	1	04	01	H8917_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H8917	005	0	1	04	01	H8917_005_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8917	006	0	1	04	01	H8917_006_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H8928	001	0	1	01	01	H8928_001_0	7		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8947	001	1	1	04	01	H8947_001_1	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	001	2	1	04	01	H8947_001_2	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	001	3	1	04	01	H8947_001_3	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	001	4	1	04	01	H8947_001_4	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	002	1	1	04	01	H8947_002_1	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	002	2	1	04	01	H8947_002_2	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	002	3	1	04	01	H8947_002_3	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8947	002	4	1	04	01	H8947_002_4	5			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001100	1																																				1	1
H8967	001	0	1	01	01	H8967_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H8967	002	0	1	01	01	H8967_002_0	6			5F4	1	4	110100	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								3	1	110	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for all tiers. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0011100	1																																				1	1
H8967	003	0	1	01	01	H8967_003_0	5		N		1	1	110110	1		2											615.00																111	34	68	102	01	34		111	34	68	102	1	31	2	1	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H8982	001	0	1	20	08	H8982_001_0	2				1																																																																				
H8982	003	0	1	20	08	H8982_003_0	2				1																																																																				
H8992	001	0	1	20	08	H8992_001_0	2				1																																																																				
H8992	002	0	1	20	08	H8992_002_0	2				1																																																																				
H9001	030	15	1	01	01	H9001_030_15	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	030	16	1	01	01	H9001_030_16	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	030	18	1	01	01	H9001_030_18	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				2	1	111	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	031	15	1	01	01	H9001_031_15	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	031	16	1	01	01	H9001_031_16	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	031	18	1	01	01	H9001_031_18	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	038	0	1	01	01	H9001_038_0	6			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				2	1	111	Features include reduced deductible, lower cost sharing on a tier-by-tier basis, additional drug dosages, forms, and manufacturers within allowable categories, and placement of drugs on lower cost-sharing tiers that contribute to a meaningful enhancement of Part D standard benefits.	2	3		0001100	1																																		1		1	1
H9001	039	0	1	01	01	H9001_039_0	4	N	N		2																																																																				
H9001	803	0	1	01	01	H9001_803_0	1				1																																																																				
H9003	001	0	1	02	01	H9003_001_0	4			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H9003	006	0	1	02	01	H9003_006_0	4			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H9003	008	0	1	02	01	H9003_008_0	4			5F2	1	4	101110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	160.00	2	0110001	1				1	1	111	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H9003	009	0	1	02	01	H9003_009_0	4			5F2	1	4	110110	1	2	2		6	5	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		3								1	1	110	Enhancements to the defined standard benefits were made through a reduced/eliminated deductible, deductible waived for at least one tier, and/or reduced cost share on some tiers as described in sections “Rx Cost Share” and “Rx Tiers.” These changes were determined to be no less than 15% richer than defined standard benefits after comparing the enhanced alternative plan OOPC value to the defined standard OOPC value in the 2026 Part D OOPC model.	2	3		0111110	1																																				1	1
H9003	801	0	1	01	01	H9003_801_0	1				1																																																																				
H9003	802	0	1	01	01	H9003_802_0	1	N	N		2																																																																				
H9042	004	0	1	04	01	H9042_004_0	7			5A4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				3	1	111	This plan offers both a reduced deductible and average coinsurance less than the defined standard benefit and passes all WS5 Alternative Coverage Tests.	1	3		0111111	1																																		1		1	1
H9042	007	0	1	04	01	H9042_007_0	7			5A4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	300.00	2	0110001	1				3	1	111	This plan offers both a reduced deductible and average coinsurance less than the defined standard benefit and passes all WS5 Alternative Coverage Tests.	1	3		0111111	1																																		1		1	1
H9042	008	0	1	04	01	H9042_008_0	5	N	N		2																																																																				
H9047	013	0	2	01	01	H9047_013_0	9			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		2	3		0001100	1																																				1	1
H9047	033	0	1	01	01	H9047_033_0	8	N	N		2																																																																				
H9047	035	0	1	02	01	H9047_035_0	8	N	N		2																																																																				
H9047	037	0	1	01	01	H9047_037_0	10			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	011		2	3		0001100	1																																				1	1
H9047	043	0	1	01	01	H9047_043_0	10		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	1	2	35.00	70.00	105.00	35.00	70.00	95.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9047	054	0	1	01	01	H9047_054_0	10			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	011		2	3		0001100	1																																				1	1
H9047	063	0	1	01	01	H9047_063_0	11			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	195.00	2	0110000	1				2	1	011		2	3		0001100	1																																				1	1
H9047	064	0	1	01	01	H9047_064_0	10			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		2	3		0001100	1																																				1	1
H9047	066	0	1	01	01	H9047_066_0	10			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		1	3		0001100	1																																				1	1
H9047	804	0	1	01	01	H9047_804_0	4				1																																																																				
H9047	805	0	1	02	01	H9047_805_0	4				1																																																																				
H9047	808	0	1	01	01	H9047_808_0	4				1																																																																				
H9047	809	0	1	02	01	H9047_809_0	4				1																																																																				
H9052	001	0	1	20	08	H9052_001_0	2				1																																																																				
H9052	002	0	1	20	08	H9052_002_0	2				1																																																																				
H9065	001	0	1	01	01	H9065_001_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H9065	002	0	1	02	01	H9065_002_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiersReduced cost sharing for select tiers at preferred pharmaciesExcluded drug coverage	1	3		0001100	3																																		1		1	1
H9065	003	0	1	02	01	H9065_003_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	150.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H9065	008	0	1	01	01	H9065_008_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	235.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.Excluded drug coverage.	1	3		0001100	3																																		1		1	1
H9066	001	0	1	01	01	H9066_001_0	5		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H9066	002	0	1	01	01	H9066_002_0	6				1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H9066	003	0	1	01	01	H9066_003_0	7		N		1	1	110110	1		2											615.00																110	30		90	01	30		100			90	1	31	2	2	35.00		105.00			105.00	35.00		35.00	25		25			25	25		25			1	1
H9068	001	0	1	20	08	H9068_001_0	2				1																																																																				
H9068	002	0	1	20	08	H9068_002_0	2				1																																																																				
H9096	001	0	1	02	01	H9096_001_0	4			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	380.00	2	0110001	1				3	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail network. Drugs on Tier 1 and Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H9096	002	0	1	02	01	H9096_002_0	4			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	300.00	2	0110001	1				3	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 and Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H9096	004	0	1	01	01	H9096_004_0	5			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				3	1	101	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by reducing Part D deductible and reducing initial coverage phase cost shares. Part D deductible does not apply to drugs on Tiers 1 & 2. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 and Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H9096	005	0	1	01	01	H9096_005_0	4			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		2	100.00	2	0110001	1				3	1	111	Plan increases actuarial value of benefits above actuarial value of defined standard prescription drug coverage by removing Part D deductible and reducing initial coverage phase cost shares. Drugs on Tier 1 have no cost-sharing from preferred retail and mail-order locations. Drugs on Tier 1 and Tier 2 use a copayment cost-share structure.	2	3		0001100	1																																		1		1	1
H9096	010	0	1	02	01	H9096_010_0	4	N	N		2																																																																				
H9096	801	0	1	01	01	H9096_801_0	3				1																																																																				
H9096	802	0	1	01	01	H9096_802_0	3				1																																																																				
H9096	803	0	1	01	01	H9096_803_0	3	N	N		2																																																																				
H9096	804	0	1	02	01	H9096_804_0	3				1																																																																				
H9096	805	0	1	02	01	H9096_805_0	3				1																																																																				
H9096	806	0	1	02	01	H9096_806_0	3	N	N		2																																																																				
H9147	001	0	1	02	01	H9147_001_0	11		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	2	3		0111100	1																																		1	1	1	1
H9153	001	0	1	01	01	H9153_001_0	4				1	1	110110	1		2											615.00																010	30			01	30		010	30			1	31			35.00			35.00			35.00		35.00	25			25			25		25			1	1
H9179	001	0	1	01	01	H9179_001_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9179	002	0	1	01	01	H9179_002_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9179	003	0	1	01	01	H9179_003_0	4	N	N		2																																																																				
H9179	801	0	1	01	01	H9179_801_0	1				1																																																																				
H9179	802	0	1	01	01	H9179_802_0	1				1																																																																				
H9185	001	0	1	20	08	H9185_001_0	2				1																																																																				
H9185	002	0	1	20	08	H9185_002_0	2				1																																																																				
H9191	001	0	1	01	01	H9191_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9191	004	0	1	01	01	H9191_004_0	5				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9191	005	0	1	01	01	H9191_005_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9207	002	0	1	01	01	H9207_002_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H9207	004	0	1	01	01	H9207_004_0	18		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Tier 6 will be the select care drug tier with STARS adherence medications will be set to $0 per script	2	3		0001110	1																																		1	1	1	1
H9207	012	0	1	01	01	H9207_012_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H9207	013	0	1	01	01	H9207_013_0	19			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H9207	015	0	1	01	01	H9207_015_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0110000	1				1	1	111	Copays are lower	2	3		0001110	1																																		1		1	1
H9207	016	0	1	01	01	H9207_016_0	16		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Tier 6 will be the select care drug tier with STARS adherence medications will be set to $0 per script	2	3		0001110	1																																		1	1	1	1
H9207	017	0	1	01	01	H9207_017_0	16		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				1	1	101	Tier 6 will be the select care drug tier with STARS adherence medications will be set to $0 per script	2	3		0001110	1																																		1	1	1	1
H9207	018	0	1	01	01	H9207_018_0	22			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	010		2	3		0001110	1																																		1		1	1
H9219	004	0	1	04	01	H9219_004_0	4	N	N		2																																																																				
H9231	002	0	1	04	01	H9231_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	005	0	1	04	01	H9231_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	006	0	1	04	01	H9231_006_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	007	0	1	04	01	H9231_007_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	010	0	1	04	01	H9231_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	011	0	1	04	01	H9231_011_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	012	0	1	04	01	H9231_012_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	015	0	1	04	01	H9231_015_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9231	016	0	1	04	01	H9231_016_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9231	017	0	1	04	01	H9231_017_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9231	018	0	1	04	01	H9231_018_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9231	019	0	1	04	01	H9231_019_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9231	020	0	1	04	01	H9231_020_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9252	001	0	1	20	08	H9252_001_0	2				1																																																																				
H9252	002	0	1	20	08	H9252_002_0	2				1																																																																				
H9266	001	0	1	20	08	H9266_001_0	2				1																																																																				
H9266	003	0	1	20	08	H9266_003_0	2				1																																																																				
H9306	002	0	1	01	01	H9306_002_0	9			5F1	1	4	110110	1	2	2		6	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Drugs		3								3	1	110	Alterwood provides a $0 cost-share when members use Tier 1 preferred generic drugs and Tier 2 generic drugs regardless of days supply. In addition, Alterwood covers generic drugs to treat erectile dysfunction at a $10 copay for a quantity of 4 units every 30 days and select prescription vitamins.	1	3		0011100	1																																				1	1
H9306	003	0	1	01	01	H9306_003_0	6	N	N		2																																																																				
H9306	004	0	1	01	01	H9306_004_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H9306	007	0	1	01	01	H9306_007_0	7		N		1	1	110110	1		2											615.00																111	30	60	90	10		10	111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00		35.00	35.00	25	25	25	25	25	25		25	25			1	1
H9306	008	1	1	01	01	H9306_008_1	7			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Alterwood provides a flat $0 cost-share when members use Tier 1 generic and a flat $8 cost-share when members use Tier 2 generic drugs regardless of days supply.	2	3		0011100	1																																				1	1
H9306	008	2	1	01	01	H9306_008_2	7			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								3	1	110	Alterwood provides a flat $0 cost-share when members use Tier 1 generic and a flat $8 cost-share when members use Tier 2 generic drugs regardless of days supply.	2	3		0011100	1																																				1	1
H9306	009	1	1	01	01	H9306_009_1	7			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				3	1	111	Alterwood provides a flat $0 cost-share when members use Tier 1 and Tier 2 generic drugs regardless of days supply.	2	3		0011100	1																																				1	1
H9306	009	2	1	01	01	H9306_009_2	7			5F	1	4	110110	1	2	2		5	4	1	2			Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				3	1	111	Alterwood provides a flat $0 cost-share when members use Tier 1 and Tier 2 generic drugs regardless of days supply.	2	3		0011100	1																																				1	1
H9314	001	0	1	01	01	H9314_001_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H9317	001	0	1	20	08	H9317_001_0	2				1																																																																				
H9317	002	0	1	20	08	H9317_002_0	2				1																																																																				
H9323	001	0	1	20	08	H9323_001_0	2				1																																																																				
H9323	002	0	1	20	08	H9323_002_0	2				1																																																																				
H9326	001	0	1	04	01	H9326_001_0	8			5F	1	3	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H9326	002	0	1	04	01	H9326_002_0	8			5F	1	3	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0001110	1																																		1		1	1
H9326	003	0	1	04	01	H9326_003_0	6	N	N		2																																																																				
H9326	801	0	1	04	01	H9326_801_0	2				1																																																																				
H9360	001	0	1	20	08	H9360_001_0	3				1																																																																				
H9360	002	0	1	20	08	H9360_002_0	3				1																																																																				
H9364	001	0	1	02	01	H9364_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9364	002	0	1	02	01	H9364_002_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	530.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9364	003	0	1	02	01	H9364_003_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	420.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9364	004	0	1	02	01	H9364_004_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9387	001	0	1	04	01	H9387_001_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9387	002	0	1	04	01	H9387_002_0	7	N	N		2																																																																				
H9387	004	0	1	04	01	H9387_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	550.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9411	001	0	1	20	08	H9411_001_0	2				1																																																																				
H9411	004	0	1	20	08	H9411_004_0	2				1																																																																				
H9412	803	0	1	04	01	H9412_803_0	1				1																																																																				
H9431	014	0	1	04	01	H9431_014_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
H9431	801	0	1	04	01	H9431_801_0	1	N	N		2																																																																				
H9438	001	0	1	20	08	H9438_001_0	2				1																																																																				
H9438	002	0	1	20	08	H9438_002_0	2				1																																																																				
H9460	001	0	1	01	01	H9460_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9460	003	0	1	01	01	H9460_003_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9468	001	0	1	20	08	H9468_001_0	2				1																																																																				
H9468	002	0	1	20	08	H9468_002_0	2				1																																																																				
H9485	001	0	1	04	01	H9485_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H9485	002	0	1	04	01	H9485_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H9485	003	0	1	04	01	H9485_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				1	1	011		1	3		0001110	3																																		1		1	1
H9485	801	0	1	04	01	H9485_801_0	1				1																																																																				
H9485	802	0	1	04	01	H9485_802_0	1	N	N		2																																																																				
H9485	803	0	1	04	01	H9485_803_0	1	N	N		2																																																																				
H9489	801	0	1	01	01	H9489_801_0	3				1																																																																				
H9489	802	0	1	02	01	H9489_802_0	3				1																																																																				
H9489	803	0	1	01	01	H9489_803_0	3				1																																																																				
H9489	804	0	1	02	01	H9489_804_0	3				1																																																																				
H9489	805	0	1	01	01	H9489_805_0	3				1																																																																				
H9489	806	0	1	02	01	H9489_806_0	3				1																																																																				
H9489	807	0	1	01	01	H9489_807_0	3	N	N		2																																																																				
H9489	808	0	1	01	01	H9489_808_0	3	N	N		2																																																																				
H9525	003	0	1	01	01	H9525_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H9525	004	0	1	02	01	H9525_004_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	315.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	006	0	1	02	01	H9525_006_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	350.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	011	0	1	02	01	H9525_011_0	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	50.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	013	1	1	02	01	H9525_013_1	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	013	2	1	02	01	H9525_013_2	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	013	3	1	02	01	H9525_013_3	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	013	4	1	02	01	H9525_013_4	5			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	013	5	1	02	01	H9525_013_5	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	230.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
H9525	018	0	1	01	01	H9525_018_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	590.00	2	0100001	1				2	1	111	$0 cost sharing for select tiers.	2	3		0001100	1																																		1	1	1	1
H9525	801	0	1	01	01	H9525_801_0	3				1																																																																				
H9525	802	0	1	01	01	H9525_802_0	4	N	N		2																																																																				
H9525	803	0	2	01	01	H9525_803_0	3				1																																																																				
H9525	804	0	1	01	01	H9525_804_0	3				1																																																																				
H9525	805	0	1	01	01	H9525_805_0	3	N	N		2																																																																				
H9525	806	0	2	01	01	H9525_806_0	4				1																																																																				
H9525	807	0	2	01	01	H9525_807_0	3	N	N		2																																																																				
H9525	809	0	1	01	01	H9525_809_0	3	N	N		2																																																																				
H9525	811	0	2	01	01	H9525_811_0	3	N	N		2																																																																				
H9525	813	0	1	01	01	H9525_813_0	3	N	N		2																																																																				
H9525	815	0	2	01	01	H9525_815_0	3	N	N		2																																																																				
H9525	816	0	2	01	01	H9525_816_0	3	N	N		2																																																																				
H9564	001	0	1	20	08	H9564_001_0	2				1																																																																				
H9564	002	0	1	20	08	H9564_002_0	2				1																																																																				
H9572	001	1	1	04	01	H9572_001_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	001	2	1	04	01	H9572_001_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	001	3	1	04	01	H9572_001_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	001	4	1	04	01	H9572_001_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	001	6	1	04	01	H9572_001_6	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	002	1	1	04	01	H9572_002_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	002	2	1	04	01	H9572_002_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	002	3	1	04	01	H9572_002_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	002	4	1	04	01	H9572_002_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	002	6	1	04	01	H9572_002_6	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	003	1	1	04	01	H9572_003_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	003	2	1	04	01	H9572_003_2	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	003	3	1	04	01	H9572_003_3	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	003	4	1	04	01	H9572_003_4	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	003	6	1	04	01	H9572_003_6	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	004	1	1	04	01	H9572_004_1	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	004	2	1	04	01	H9572_004_2	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	004	4	1	04	01	H9572_004_4	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	004	6	1	04	01	H9572_004_6	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	007	1	1	04	01	H9572_007_1	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	007	2	1	04	01	H9572_007_2	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	007	3	1	04	01	H9572_007_3	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	007	4	1	04	01	H9572_007_4	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	007	6	1	04	01	H9572_007_6	8			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	008	0	1	04	01	H9572_008_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We fulfill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	009	0	1	04	01	H9572_009_0	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				1	1	111	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
H9572	010	0	1	04	01	H9572_010_0	7			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				1					3		0001110	1																																		1		1	1
H9572	801	0	1	04	01	H9572_801_0	2				1																																																																				
H9572	802	0	1	04	01	H9572_802_0	2	N	N		2																																																																				
H9572	806	0	1	04	01	H9572_806_0	2				1																																																																				
H9572	807	0	1	04	01	H9572_807_0	2	N	N		2																																																																				
H9589	003	0	1	04	01	H9589_003_0	7			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	400.00	2	0110001	1				1	1	111	This plan offers lower copays or coinsurance compared to the standard prescription drug coverage. The beneficiaries pay less out-of-pocket for their medications.	2	3		0001110	1																																		1		1	1
H9590	001	0	1	01	01	H9590_001_0	4				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H9592	001	0	1	20	08	H9592_001_0	2				1																																																																				
H9592	002	0	1	20	08	H9592_002_0	2				1																																																																				
H9615	021	0	1	04	01	H9615_021_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The plan has lowered the deductible to $0 for tier 1 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H9615	022	0	1	04	01	H9615_022_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The plan has lowered the deductible to $0 for tier 1 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H9615	023	0	1	04	01	H9615_023_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The plan has lowered the deductible to $0 for tier 1 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H9615	024	0	1	04	01	H9615_024_0	16			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	The plan has lowered the deductible to $0 for tier 1 and reduced cost sharing via copays for tiers 1/2 in the coverage phase.	2	3		0111110	1																																		1		1	1
H9615	802	0	1	04	01	H9615_802_0	7				1																																																																				
H9615	807	0	1	04	01	H9615_807_0	7				1																																																																				
H9615	810	0	1	04	01	H9615_810_0	7	N	N		2																																																																				
H9615	811	0	1	04	01	H9615_811_0	7	N	N		2																																																																				
H9616	001	0	1	20	08	H9616_001_0	2				1																																																																				
H9616	002	0	1	20	08	H9616_002_0	2				1																																																																				
H9623	001	0	1	01	01	H9623_001_0	7		N		1	1	110110	1		2											615.00																111	30	60	100	01	30		111	30	60	100	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9630	002	0	1	02	01	H9630_002_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9630	008	0	1	02	01	H9630_008_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9630	010	0	1	02	01	H9630_010_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9630	011	0	1	02	01	H9630_011_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	480.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9630	014	0	1	02	01	H9630_014_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9630	015	0	1	02	01	H9630_015_0	7	N	N		2																																																																				
H9649	001	0	1	20	08	H9649_001_0	2				1																																																																				
H9649	002	0	1	20	08	H9649_002_0	2				1																																																																				
H9678	002	0	1	04	01	H9678_002_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				1	1	101	This plan fulfills the requirement to increase the actuarial value of benefits above that of defined standard prescription drug coverage by reducing coverage phase cost sharing on tiers 1-3, leading to lower overall out-of-pocket costs for members.	1	3		0111111	3																																		1		1	1
H9686	004	0	1	01	01	H9686_004_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																				1	1
H9686	005	0	1	01	01	H9686_005_0	8		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1	1	1	1
H9686	006	0	1	01	01	H9686_006_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	2	3		0111100	1																																		1		1	1
H9686	007	0	1	01	01	H9686_007_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H9686	008	0	1	01	01	H9686_008_0	10			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0111001	1				2	1	101	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers.	1	3		0111100	3																																		1		1	1
H9686	009	0	1	01	01	H9686_009_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		3								2	1	110	This PBP's design increases the actuarial value of benefits above the defined standard design through reductions in cost sharing for select tiers. It also reduces member cost sharing by lowering members' liability to satisfy the deductible requirement of the defined standard benefit.	1	3		0111100	3																																		1		1	1
H9686	801	0	1	01	01	H9686_801_0	1				1																																																																				
H9686	802	0	1	01	01	H9686_802_0	1				1																																																																				
H9686	803	0	1	01	01	H9686_803_0	1	N	N		2																																																																				
H9686	804	0	1	01	01	H9686_804_0	1	N	N		2																																																																				
H9690	001	0	1	01	01	H9690_001_0	4				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9699	007	0	1	01	01	H9699_007_0	5			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	460.00	2	0110000	1				2	1	111	$0 cost sharing for generics on Tier 1$5 cost sharing for drugs on Tier 217% coinsurance for drugs on Tier 3	2	3		0001110	1																																		1		1	1
H9700	001	0	1	04	01	H9700_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	002	0	1	04	01	H9700_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	003	0	1	04	01	H9700_003_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	004	0	1	04	01	H9700_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	005	0	1	04	01	H9700_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	370.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	006	0	1	04	01	H9700_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	007	0	1	04	01	H9700_007_0	4	N	N		2																																																																				
H9700	008	0	1	04	01	H9700_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	270.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9700	009	0	1	04	01	H9700_009_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9706	001	0	1	01	01	H9706_001_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H9706	002	0	1	01	01	H9706_002_0	6		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	1	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9706	005	0	1	01	01	H9706_005_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H9706	007	0	1	01	01	H9706_007_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H9706	008	0	1	01	01	H9706_008_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H9706	009	0	1	01	01	H9706_009_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				2	1	111	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and a reduced Part D deductible, which is further waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
H9706	801	0	1	01	01	H9706_801_0	2				1																																																																				
H9706	802	0	1	01	01	H9706_802_0	2				1																																																																				
H9706	803	0	1	01	01	H9706_803_0	2	N	N		2																																																																				
H9725	003	0	1	01	01	H9725_003_0	6		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H9725	005	0	1	01	01	H9725_005_0	4	N	N		2																																																																				
H9725	009	1	1	01	01	H9725_009_1	7			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	009	2	1	01	01	H9725_009_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	009	3	1	01	01	H9725_009_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	009	4	1	01	01	H9725_009_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	013	0	1	01	01	H9725_013_0	6		N	5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	2	3		0111110	1																																		1	1	1	1
H9725	014	0	1	01	01	H9725_014_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	295.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	015	1	1	01	01	H9725_015_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	015	2	1	01	01	H9725_015_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	015	3	1	01	01	H9725_015_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	015	4	1	01	01	H9725_015_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	016	0	1	01	01	H9725_016_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	017	1	1	01	01	H9725_017_1	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	017	2	1	01	01	H9725_017_2	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	017	3	1	01	01	H9725_017_3	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	017	4	1	01	01	H9725_017_4	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	018	0	1	02	01	H9725_018_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	This plan offers coverage for excluded drugs, and reduced cost share at preferred pharmacies.	1	3		0111110	3																																		1		1	1
H9725	019	0	1	01	01	H9725_019_0	4	N	N		2																																																																				
H9725	801	0	1	01	01	H9725_801_0	3				1																																																																				
H9730	003	0	1	02	01	H9730_003_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	510.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9730	004	0	1	02	01	H9730_004_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	430.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9730	007	0	1	02	01	H9730_007_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9730	009	0	1	02	01	H9730_009_0	8			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	1	3		0001100	1																																		1		1	1
H9730	010	0	1	02	01	H9730_010_0	8			5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	550.00	2	0100001	1				2					3		0001100	1																																		1		1	1
H9730	011	0	1	02	01	H9730_011_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	570.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9771	001	0	1	01	01	H9771_001_0	2		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1	1	1	1
H9802	001	0	1	04	01	H9802_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	230.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9802	002	0	1	04	01	H9802_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9802	004	0	1	04	01	H9802_004_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H9802	006	0	1	04	01	H9802_006_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9802	008	0	1	04	01	H9802_008_0	6		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H9802	009	0	1	04	01	H9802_009_0	7			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9808	004	0	1	04	01	H9808_004_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0111000	1				3	1	111	This plan charges a deductible that is well below the defined standard deductible.  The deductible only applies to tiers 4 and 5.  Copays are applied to tiers 1-2.	1	3		0001100	1																																		1		1	1
H9808	005	0	1	04	01	H9808_005_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0111000	1				3	1	111	This plan charges a deductible that is well below the defined standard deductible.  The deductible only applies to tiers 4 and 5.  Copays are applied to tiers 1-2.	1	3		0001100	1																																		1		1	1
H9808	009	0	1	04	01	H9808_009_0	4	N	N		2																																																																				
H9808	010	0	1	04	01	H9808_010_0	6			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	300.00	2	0111000	1				3	1	111	This plan charges a deductible that is well below the defined standard deductible.  The deductible only applies to tiers 4 and 5.  Copays are applied to tiers 1-2.	1	3		0001100	1																																		1		1	1
H9808	807	0	1	04	01	H9808_807_0	1				1																																																																				
H9808	808	0	1	04	01	H9808_808_0	1				1																																																																				
H9811	801	0	1	01	01	H9811_801_0	3				1																																																																				
H9826	003	0	1	01	01	H9826_003_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	001		2	3		0001100	1																																		1	1	1	1
H9826	004	0	1	01	01	H9826_004_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	001		2	3		0001100	1																																		1	1	1	1
H9827	001	0	1	01	01	H9827_001_0	7			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	125.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9827	003	0	1	01	01	H9827_003_0	4	N	N		2																																																																				
H9827	004	0	1	01	01	H9827_004_0	6			5F	1	4	110110	1	2	2		5	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	275.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9827	801	0	1	01	01	H9827_801_0	1				1																																																																				
H9827	802	0	1	01	01	H9827_802_0	1				1																																																																				
H9830	001	0	1	20	08	H9830_001_0	2				1																																																																				
H9830	002	0	1	20	08	H9830_002_0	2				1																																																																				
H9834	001	0	1	01	01	H9834_001_0	5			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	200.00	2	0110001	1				2	1	111	•Plan includes a deductible of $200 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H9834	003	0	1	01	01	H9834_003_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	225.00	2	0110001	1				2	1	111	•Plan includes a deductible of $225 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H9834	004	0	1	01	01	H9834_004_0	3	N	N		2																																																																				
H9834	006	0	1	01	01	H9834_006_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H9834	007	0	1	01	01	H9834_007_0	4			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	270.00	2	0110001	1				2	1	111	•Plan includes a deductible of $270 applied to tier 3, 4, and 5 which is less than the defined standard of $615.•Plan includes copays for preferred generic and generic of $2 and $10 respectively.	2	3		0001100	1																																		1		1	1
H9842	001	0	1	20	08	H9842_001_0	2				1																																																																				
H9842	002	0	1	20	08	H9842_002_0	2				1																																																																				
H9884	008	0	1	04	01	H9884_008_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9884	013	0	1	04	01	H9884_013_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9884	014	0	1	04	01	H9884_014_0	4	N	N		2																																																																				
H9884	015	0	1	04	01	H9884_015_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	595.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	001	0	1	04	01	H9888_001_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	002	0	1	04	01	H9888_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	005	0	1	04	01	H9888_005_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	006	0	1	04	01	H9888_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	007	0	1	04	01	H9888_007_0	4	N	N		2																																																																				
H9888	008	0	1	04	01	H9888_008_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	009	0	1	04	01	H9888_009_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9888	010	0	1	04	01	H9888_010_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	395.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9888	011	0	1	04	01	H9888_011_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9888	012	0	1	04	01	H9888_012_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9888	013	0	1	04	01	H9888_013_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H9888	014	0	1	04	01	H9888_014_0	5		N	5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2	1	101	The plan offers $0 cost sharing on select drugs and a supplemental non-Part D drug benefit covering ED drugs.	1	3		0111110	3																																		1	1	1	1
H9888	015	0	1	04	01	H9888_015_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9904	001	0	1	04	01	H9904_001_0	7			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	250.00	2	0110000	1				2	1	111	No cost sharing on tiers 1 and 2.	1	3		0001100	1																																		1		1	1
H9904	002	0	1	04	01	H9904_002_0	9			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	Copays are applied to tiers 1-3.	1	3		0001100	1																																		1		1	1
H9907	002	1	1	04	01	H9907_002_1	10			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H9907	002	2	1	04	01	H9907_002_2	10			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H9907	002	3	1	04	01	H9907_002_3	10			5F2	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines		1	615.00	2	0110001	1				2	1	101	The plan offers reduced cost sharing on many generic drugs.	1	3		0111100	1																																		1		1	1
H9907	801	0	1	04	01	H9907_801_0	4				1																																																																				
H9907	802	0	1	04	01	H9907_802_0	4				1																																																																				
H9907	803	0	1	04	01	H9907_803_0	4	N	N		2																																																																				
H9907	804	0	1	04	01	H9907_804_0	4	N	N		2																																																																				
H9909	001	0	1	01	01	H9909_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9916	001	0	1	02	01	H9916_001_0	8		N	5F4	1	3	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	450.00	2	0100001	1				2					3		0001100	1																																		1	1	1	1
H9917	001	0	1	01	01	H9917_001_0	5				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	2	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H9917	004	0	1	01	01	H9917_004_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	450.00	2	0110000	1				3	1	111	The plan has lowered the deductible to $0 for Tiers 1 & 2 and $450 for Tiers 3-5, and reduced copay cost-share for tiers 1-4 in the coverage phase.	2	3		0001100	1																																				1	1
H9942	001	0	1	04	01	H9942_001_0	6				1	1	110100	1		2											615.00																111	30	60	90	10		10	000				1	31	2	1	35.00	70.00	105.00					35.00	35.00	25	25	25					25	25			1	1
H9942	002	0	1	04	01	H9942_002_0	6				1	1	110100	1		2											615.00																111	30	60	90	01	30		000				1	31	2	1	35.00	70.00	105.00				35.00		35.00	25	25	25				25		25			1	1
H9955	007	0	1	01	01	H9955_007_0	8		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H9955	008	0	1	01	01	H9955_008_0	9		N	5F4	1	4	110110	1	2	2		6	5	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				1	1	101	Reduced cost share on Tiers 1, 2, 3, and 6. Deductible waived on Tiers 1 and 6.	2	3		0001110	1																																		1	1	1	1
H9968	001	0	1	01	01	H9968_001_0	3				1	1	110110	1		2											615.00																111	30	60	90	01	30		111	30	60	90	1	31	2	2	35.00	70.00	105.00	35.00	70.00	105.00	35.00		35.00	25	25	25	25	25	25	25		25			1	1
H9977	001	0	1	01	01	H9977_001_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	375.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9977	002	0	1	01	01	H9977_002_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9977	003	0	1	01	01	H9977_003_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9977	004	0	1	01	01	H9977_004_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9977	005	0	1	01	01	H9977_005_0	6			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	175.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9977	006	0	1	01	01	H9977_006_0	5			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	605.00	2	0110000	1				2	1	111	The plan offers a reduced deductible and reduced cost sharing on many generic drugs.	1	3		0111110	3																																		1		1	1
H9977	007	0	1	01	01	H9977_007_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0111110	1																																		1		1	1
H9986	001	0	1	01	01	H9986_001_0	7				1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H9986	002	0	1	02	01	H9986_002_0	8				1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H9986	004	1	1	02	01	H9986_004_1	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H9986	004	2	1	02	01	H9986_004_2	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H9986	004	3	1	02	01	H9986_004_3	10		N		1	1	110110	1		2											615.00																111	30	60	90	01	30		100			90	1	31	2	2	35.00	70.00	105.00			105.00	35.00		35.00	25	25	25			25	25		25			1	1
H9998	001	0	1	20	08	H9998_001_0	2				1																																																																				
H9998	002	0	1	20	08	H9998_002_0	2				1																																																																				
R0110	001	0	1	31	11	R0110_001_0	3	N	N		2																																																																				
R0110	003	0	1	31	11	R0110_003_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	100.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	004	0	1	31	11	R0110_004_0	3	N	N		2																																																																				
R0110	005	0	1	31	11	R0110_005_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	006	0	1	31	11	R0110_006_0	4	N	N		2																																																																				
R0110	007	0	1	31	11	R0110_007_0	3	N	N		2																																																																				
R0110	008	0	1	31	11	R0110_008_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	011	0	1	31	11	R0110_011_0	3	N	N		2																																																																				
R0110	012	0	1	31	11	R0110_012_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	350.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	013	0	1	31	11	R0110_013_0	2	N	N		2																																																																				
R0110	014	0	1	31	11	R0110_014_0	3				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
R0110	015	0	1	31	11	R0110_015_0	2	N	N		2																																																																				
R0110	016	0	1	31	11	R0110_016_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
R0110	017	0	1	31	11	R0110_017_0	2	N	N		2																																																																				
R0110	018	0	1	31	11	R0110_018_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	590.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	019	0	1	31	11	R0110_019_0	2	N	N		2																																																																				
R0110	020	0	1	31	11	R0110_020_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R0110	801	0	1	31	11	R0110_801_0	2				1																																																																				
R0110	802	0	1	31	11	R0110_802_0	2	N	N		2																																																																				
R0110	804	0	1	31	11	R0110_804_0	1				1																																																																				
R0110	805	0	1	31	11	R0110_805_0	1	N	N		2																																																																				
R0110	806	0	1	31	11	R0110_806_0	1				1																																																																				
R0110	807	0	1	31	11	R0110_807_0	1	N	N		2																																																																				
R0110	808	0	1	31	11	R0110_808_0	1				1																																																																				
R0110	809	0	1	31	11	R0110_809_0	1	N	N		2																																																																				
R0110	810	0	1	31	11	R0110_810_0	1				1																																																																				
R0110	811	0	1	31	11	R0110_811_0	1	N	N		2																																																																				
R0110	812	0	1	31	11	R0110_812_0	1				1																																																																				
R0110	813	0	1	31	11	R0110_813_0	1	N	N		2																																																																				
R0110	814	0	1	31	11	R0110_814_0	1				1																																																																				
R0110	815	0	1	31	11	R0110_815_0	1	N	N		2																																																																				
R0110	816	0	1	31	11	R0110_816_0	1				1																																																																				
R0110	817	0	1	31	11	R0110_817_0	1	N	N		2																																																																				
R0759	001	0	1	31	11	R0759_001_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
R0759	002	0	1	31	11	R0759_002_0	4	N	N		2																																																																				
R0759	003	0	1	31	11	R0759_003_0	5		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
R1532	001	0	1	31	11	R1532_001_0	4	N	N		2																																																																				
R1532	002	0	1	31	11	R1532_002_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
R1532	801	0	1	31	11	R1532_801_0	1				1																																																																				
R1532	802	0	1	31	11	R1532_802_0	2	N	N		2																																																																				
R2604	002	0	1	31	11	R2604_002_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
R2604	005	0	1	31	11	R2604_005_0	5	N	N		2																																																																				
R3175	807	0	1	31	11	R3175_807_0	1	N	N		2																																																																				
R3444	008	0	1	31	11	R3444_008_0	4				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
R3444	009	0	1	31	11	R3444_009_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
R3444	012	0	1	31	11	R3444_012_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
R4182	001	0	1	31	11	R4182_001_0	3	N	N		2																																																																				
R4182	003	0	1	31	11	R4182_003_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R4182	004	0	1	31	11	R4182_004_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R4182	801	0	1	31	11	R4182_801_0	1				1																																																																				
R4182	802	0	1	31	11	R4182_802_0	2	N	N		2																																																																				
R5342	805	0	1	31	11	R5342_805_0	1	N	N		2																																																																				
R5361	001	0	1	31	11	R5361_001_0	3	N	N		2																																																																				
R5361	002	0	1	31	11	R5361_002_0	3			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
R5361	801	0	1	31	11	R5361_801_0	2				1																																																																				
R5361	802	0	1	31	11	R5361_802_0	1	N	N		2																																																																				
R5826	005	0	1	31	11	R5826_005_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0111000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
R5826	018	0	1	31	11	R5826_018_0	2	N	N		2																																																																				
R5826	074	0	1	31	11	R5826_074_0	2				1	1	110110	1		2											615.00																110	30		100	01	30		110	30		100	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
R5826	805	0	1	31	11	R5826_805_0	2				1																																																																				
R5826	819	0	1	31	11	R5826_819_0	3	N	N		2																																																																				
R5941	013	0	1	31	11	R5941_013_0	6	N	N		2																																																																				
R5941	014	0	1	31	11	R5941_014_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	250.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
R5941	016	0	1	31	11	R5941_016_0	6			5F4	1	4	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		2	45.00	2	0110001	1				2	1	111	$0 cost sharing for select tiers.Reduced cost sharing for select tiers at preferred pharmacies.	2	3		0001100	1																																		1		1	1
R6694	006	0	1	31	11	R6694_006_0	3			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				3	1	101	This plan fulfills the requirement to increase the actuarial value of defined standard prescription drug coverage by offering reduced copays for certain formulary tiers and a Part D deductible waived for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0001110	1																																		1		1	1
R6801	008	0	1	31	11	R6801_008_0	4			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	584.00	1						2	1	110	Members have a reduced deductible below the standard benefit, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1		1	1
R6801	009	0	1	31	11	R6801_009_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
R6801	011	0	1	31	11	R6801_011_0	4		N	5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2	1	101	Member's deductible only applies to Tiers 2, 3, 4 and 5, Members pay copays instead of coinsurance on tier 1 .	2	3		0001110	1																																		1	1	1	1
R6801	012	0	1	31	11	R6801_012_0	4			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	600.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2 and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
R7220	001	0	1	31	11	R7220_001_0	3	N	N		2																																																																				
R7220	002	0	1	31	11	R7220_002_0	2			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
R7220	801	0	1	31	11	R7220_801_0	1				1																																																																				
R7220	802	0	1	31	11	R7220_802_0	2	N	N		2																																																																				
R7444	808	0	1	31	11	R7444_808_0	1				1																																																																				
S0262	830	0		29	10	S0262_830_0	2				1																																																																				
S0262	832	0		29	10	S0262_832_0	2				1																																																																				
S0262	833	0		29	10	S0262_833_0	2				1																																																																				
S0262	834	0		29	10	S0262_834_0	2				1																																																																				
S0262	835	0		29	10	S0262_835_0	2				1																																																																				
S0262	836	0		29	10	S0262_836_0	2				1																																																																				
S0375	801	0		29	10	S0375_801_0	3				1																																																																				
S0375	802	0		29	10	S0375_802_0	3				1																																																																				
S0586	801	0		29	10	S0586_801_0	7				1																																																																				
S1030	001	0		29	10	S1030_001_0	3			5F	1	4	110110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	150.00	2	0110000	1				2	1	111	The $615 deductible has been eliminated on Tiers 1 and 2. The defined standard cost sharing in the initial coverage phase has been replaced with a $0 copayment on Tier 1 and non-zero dollar copayments on Tier 2. Tiers 3, 4, and 5 have coinsurance.	2	3		0111100	1																																		1		1	1
S1030	006	0		29	10	S1030_006_0	3			5F	1	2	110110	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S1030	801	0		29	10	S1030_801_0	1				1																																																																				
S1030	802	0		29	10	S1030_802_0	1				1																																																																				
S1030	803	0		29	10	S1030_803_0	1				1																																																																				
S1030	804	0		29	10	S1030_804_0	1				1																																																																				
S1030	805	0		29	10	S1030_805_0	1				1																																																																				
S1140	801	0		29	10	S1140_801_0	1				1																																																																				
S1140	802	0		29	10	S1140_802_0	1				1																																																																				
S1822	801	0		29	10	S1822_801_0	1				1																																																																				
S1822	802	0		29	10	S1822_802_0	1				1																																																																				
S1822	803	0		29	10	S1822_803_0	1				1																																																																				
S1822	804	0		29	10	S1822_804_0	1				1																																																																				
S2135	801	0		29	10	S2135_801_0	1				1																																																																				
S2135	802	0		29	10	S2135_802_0	1				1																																																																				
S2135	804	0		29	10	S2135_804_0	1				1																																																																				
S2135	805	0		29	10	S2135_805_0	1				1																																																																				
S2135	806	0		29	10	S2135_806_0	1				1																																																																				
S2135	807	0		29	10	S2135_807_0	1				1																																																																				
S2468	003	0		29	10	S2468_003_0	4			5F	1	3	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						1					3		0001100	1																																		1		1	1
S2468	004	0		29	10	S2468_004_0	4			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	This plan increases the actuarial value of benefits by offering reduced cost sharing for drugs in Tiers 1 and 2.	2	3		0001100	1																																		1		1	1
S2468	801	0		29	10	S2468_801_0	3				1																																																																				
S2468	802	0		29	10	S2468_802_0	3				1																																																																				
S2893	001	0		29	10	S2893_001_0	2			5F	1	3	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111110	1																																		1		1	1
S2893	003	0		29	10	S2893_003_0	2			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	010		2	3		0111110	1																																		1		1	1
S2893	801	0		29	10	S2893_801_0	2				1																																																																				
S2893	802	0		29	10	S2893_802_0	2				1																																																																				
S3285	801	0		29	10	S3285_801_0	1				1																																																																				
S3285	802	0		29	10	S3285_802_0	1				1																																																																				
S3285	803	0		29	10	S3285_803_0	1				1																																																																				
S3285	804	0		29	10	S3285_804_0	1				1																																																																				
S3285	805	0		29	10	S3285_805_0	1				1																																																																				
S3285	806	0		29	10	S3285_806_0	1				1																																																																				
S3285	807	0		29	10	S3285_807_0	1				1																																																																				
S3285	808	0		29	10	S3285_808_0	1				1																																																																				
S3285	809	0		29	10	S3285_809_0	1				1																																																																				
S3285	810	0		29	10	S3285_810_0	1				1																																																																				
S3285	811	0		29	10	S3285_811_0	1				1																																																																				
S3285	812	0		29	10	S3285_812_0	1				1																																																																				
S3285	813	0		29	10	S3285_813_0	1				1																																																																				
S3285	814	0		29	10	S3285_814_0	1				1																																																																				
S3285	815	0		29	10	S3285_815_0	1				1																																																																				
S3285	816	0		29	10	S3285_816_0	1				1																																																																				
S3285	817	0		29	10	S3285_817_0	1				1																																																																				
S3285	818	0		29	10	S3285_818_0	1				1																																																																				
S3389	802	0		29	10	S3389_802_0	4				1																																																																				
S3389	803	0		29	10	S3389_803_0	4				1																																																																				
S3389	804	0		29	10	S3389_804_0	4				1																																																																				
S3521	801	0		29	10	S3521_801_0	3				1																																																																				
S3875	802	0		29	10	S3875_802_0	2				1																																																																				
S3875	803	0		29	10	S3875_803_0	1				1																																																																				
S3875	804	0		29	10	S3875_804_0	1				1																																																																				
S3875	805	0		29	10	S3875_805_0	1				1																																																																				
S3875	806	0		29	10	S3875_806_0	1				1																																																																				
S3875	807	0		29	10	S3875_807_0	1				1																																																																				
S3875	808	0		29	10	S3875_808_0	1				1																																																																				
S3875	809	0		29	10	S3875_809_0	1				1																																																																				
S3875	810	0		29	10	S3875_810_0	1				1																																																																				
S3875	811	0		29	10	S3875_811_0	1				1																																																																				
S3994	801	0		29	10	S3994_801_0	3				1																																																																				
S3994	802	0		29	10	S3994_802_0	3				1																																																																				
S4501	801	0		29	10	S4501_801_0	4				1																																																																				
S4501	802	0		29	10	S4501_802_0	4				1																																																																				
S4501	803	0		29	10	S4501_803_0	4				1																																																																				
S4501	804	0		29	10	S4501_804_0	4				1																																																																				
S4501	805	0		29	10	S4501_805_0	4				1																																																																				
S4501	806	0		29	10	S4501_806_0	4				1																																																																				
S4501	807	0		29	10	S4501_807_0	4				1																																																																				
S4501	808	0		29	10	S4501_808_0	4				1																																																																				
S4501	809	0		29	10	S4501_809_0	4				1																																																																				
S4501	810	0		29	10	S4501_810_0	4				1																																																																				
S4501	811	0		29	10	S4501_811_0	4				1																																																																				
S4501	812	0		29	10	S4501_812_0	4				1																																																																				
S4501	813	0		29	10	S4501_813_0	4				1																																																																				
S4501	814	0		29	10	S4501_814_0	4				1																																																																				
S4501	815	0		29	10	S4501_815_0	4				1																																																																				
S4501	816	0		29	10	S4501_816_0	4				1																																																																				
S4802	012	0		29	10	S4802_012_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	013	0		29	10	S4802_013_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	014	0		29	10	S4802_014_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	020	0		29	10	S4802_020_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	021	0		29	10	S4802_021_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	069	0		29	10	S4802_069_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	070	0		29	10	S4802_070_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	071	0		29	10	S4802_071_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	072	0		29	10	S4802_072_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	073	0		29	10	S4802_073_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	074	0		29	10	S4802_074_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	075	0		29	10	S4802_075_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	076	0		29	10	S4802_076_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	077	0		29	10	S4802_077_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	078	0		29	10	S4802_078_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	079	0		29	10	S4802_079_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	080	0		29	10	S4802_080_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	081	0		29	10	S4802_081_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	082	0		29	10	S4802_082_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	083	0		29	10	S4802_083_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	084	0		29	10	S4802_084_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	085	0		29	10	S4802_085_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	086	0		29	10	S4802_086_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	087	0		29	10	S4802_087_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	088	0		29	10	S4802_088_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	089	0		29	10	S4802_089_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	090	0		29	10	S4802_090_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	091	0		29	10	S4802_091_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	092	0		29	10	S4802_092_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	093	0		29	10	S4802_093_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	094	0		29	10	S4802_094_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	095	0		29	10	S4802_095_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	096	0		29	10	S4802_096_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	097	0		29	10	S4802_097_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001100																																			1		1	1
S4802	132	0		29	10	S4802_132_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	133	0		29	10	S4802_133_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	134	0		29	10	S4802_134_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	135	0		29	10	S4802_135_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	136	0		29	10	S4802_136_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	137	0		29	10	S4802_137_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	138	0		29	10	S4802_138_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	139	0		29	10	S4802_139_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	140	0		29	10	S4802_140_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	141	0		29	10	S4802_141_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	142	0		29	10	S4802_142_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	143	0		29	10	S4802_143_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	144	0		29	10	S4802_144_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	145	0		29	10	S4802_145_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	146	0		29	10	S4802_146_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	147	0		29	10	S4802_147_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	148	0		29	10	S4802_148_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	149	0		29	10	S4802_149_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	150	0		29	10	S4802_150_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	151	0		29	10	S4802_151_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	152	0		29	10	S4802_152_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	153	0		29	10	S4802_153_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	154	0		29	10	S4802_154_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	155	0		29	10	S4802_155_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	156	0		29	10	S4802_156_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	157	0		29	10	S4802_157_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	158	0		29	10	S4802_158_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	159	0		29	10	S4802_159_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	160	0		29	10	S4802_160_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	161	0		29	10	S4802_161_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	162	0		29	10	S4802_162_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	163	0		29	10	S4802_163_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	164	0		29	10	S4802_164_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4802	165	0		29	10	S4802_165_0	4			5F4	1	4	101101	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110000	1				2	1	101	Per CMS Guidance for Enhanced Alternative plans, the Contract PBP met all the conditions prescribed by CMS.  In the BPTs, the following plan passed the Actuarial Tests to ensure the plan is Enhanced relative to Defined Standard.  Finally, the Contract PBP passed the OOPC and TBC tests mandated by CMS.	2	3		0001100	1																																		1		1	1
S4983	801	0		29	10	S4983_801_0	4				1																																																																				
S5450	801	0		29	10	S5450_801_0	1				1																																																																				
S5450	802	0		29	10	S5450_802_0	1				1																																																																				
S5450	803	0		29	10	S5450_803_0	1				1																																																																				
S5450	804	0		29	10	S5450_804_0	1				1																																																																				
S5450	805	0		29	10	S5450_805_0	1				1																																																																				
S5450	806	0		29	10	S5450_806_0	1				1																																																																				
S5450	807	0		29	10	S5450_807_0	1				1																																																																				
S5540	002	0		29	10	S5540_002_0	6			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0100000	1				2					3		0111100	1																																		1		1	1
S5540	004	0		29	10	S5540_004_0	9			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	As demonstrated on Worksheet 5 of the Part D BPT, the average expected coinsurance for actual costs for covered Part D drugs covered under the Part D plan above the deductible and up to the catastrophic threshold is less than 25 percent. This represents an increase in the actuarial value of benefits under the Part D plan above the actuarial value of defined standard prescription drug coverage.	2	3		0111100	1																																		1		1	1
S5540	803	0		29	10	S5540_803_0	6				1																																																																				
S5540	804	0		29	10	S5540_804_0	6				1																																																																				
S5584	001	0		29	10	S5584_001_0	4			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						1					3		0001110	1																																		1		1	1
S5584	002	0		29	10	S5584_002_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								1	1	110	We full fill that requirement through reduced deductibles and/or copays/coinsurance.	2	3		0001110	1																																		1		1	1
S5584	801	0		29	10	S5584_801_0	2				1																																																																				
S5584	802	0		29	10	S5584_802_0	2				1																																																																				
S5593	002	0		29	10	S5593_002_0	3				1	1	110110	1		2											615.00																110	31		100	01	31		100			100	1	31	1	2	35.00		105.00			105.00	35.00		35.00	20		20			20	20		20			1	1
S5593	003	0		29	10	S5593_003_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				1	1	111	The enhanced alternative plan provides members with access to generic drugs at low Tier 1 and Tier 2 copay levels without any applicable deductible.	2	3		0001100	1																																		1		1	1
S5593	801	0		29	10	S5593_801_0	2				1																																																																				
S5593	802	0		29	10	S5593_802_0	2				1																																																																				
S5593	807	0		29	10	S5593_807_0	2				1																																																																				
S5593	808	0		29	10	S5593_808_0	3				1																																																																				
S5596	803	0		29	10	S5596_803_0	1				1																																																																				
S5596	804	0		29	10	S5596_804_0	1				1																																																																				
S5596	844	0		29	10	S5596_844_0	1				1																																																																				
S5596	845	0		29	10	S5596_845_0	1				1																																																																				
S5596	846	0		29	10	S5596_846_0	1				1																																																																				
S5596	847	0		29	10	S5596_847_0	1				1																																																																				
S5596	848	0		29	10	S5596_848_0	1				1																																																																				
S5601	002	0		29	10	S5601_002_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	004	0		29	10	S5601_004_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	006	0		29	10	S5601_006_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	008	0		29	10	S5601_008_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	010	0		29	10	S5601_010_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	012	0		29	10	S5601_012_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	014	0		29	10	S5601_014_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	016	0		29	10	S5601_016_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	018	0		29	10	S5601_018_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	020	0		29	10	S5601_020_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	022	0		29	10	S5601_022_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	024	0		29	10	S5601_024_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	026	0		29	10	S5601_026_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	028	0		29	10	S5601_028_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	030	0		29	10	S5601_030_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	032	0		29	10	S5601_032_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	034	0		29	10	S5601_034_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	036	0		29	10	S5601_036_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	038	0		29	10	S5601_038_0	1			5F	1	2	110100	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	040	0		29	10	S5601_040_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	042	0		29	10	S5601_042_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	044	0		29	10	S5601_044_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	048	0		29	10	S5601_048_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	050	0		29	10	S5601_050_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	052	0		29	10	S5601_052_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	054	0		29	10	S5601_054_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	056	0		29	10	S5601_056_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	058	0		29	10	S5601_058_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	060	0		29	10	S5601_060_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	062	0		29	10	S5601_062_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	064	0		29	10	S5601_064_0	2			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	066	0		29	10	S5601_066_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	068	0		29	10	S5601_068_0	1			5F	1	2	110110	1		2		5	4	2		3	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5601	801	0		29	10	S5601_801_0	1				1																																																																				
S5601	802	0		29	10	S5601_802_0	1				1																																																																				
S5601	803	0		29	10	S5601_803_0	1				1																																																																				
S5601	804	0		29	10	S5601_804_0	1				1																																																																				
S5601	805	0		29	10	S5601_805_0	1				1																																																																				
S5601	806	0		29	10	S5601_806_0	1				1																																																																				
S5601	807	0		29	10	S5601_807_0	1				1																																																																				
S5601	808	0		29	10	S5601_808_0	1				1																																																																				
S5601	809	0		29	10	S5601_809_0	1				1																																																																				
S5601	810	0		29	10	S5601_810_0	1				1																																																																				
S5601	811	0		29	10	S5601_811_0	1				1																																																																				
S5601	812	0		29	10	S5601_812_0	1				1																																																																				
S5601	813	0		29	10	S5601_813_0	1				1																																																																				
S5601	814	0		29	10	S5601_814_0	1				1																																																																				
S5601	815	0		29	10	S5601_815_0	1				1																																																																				
S5601	816	0		29	10	S5601_816_0	1				1																																																																				
S5601	818	0		29	10	S5601_818_0	1				1																																																																				
S5601	820	0		29	10	S5601_820_0	1				1																																																																				
S5601	822	0		29	10	S5601_822_0	1				1																																																																				
S5601	823	0		29	10	S5601_823_0	1				1																																																																				
S5601	824	0		29	10	S5601_824_0	1				1																																																																				
S5601	825	0		29	10	S5601_825_0	1				1																																																																				
S5601	826	0		29	10	S5601_826_0	1				1																																																																				
S5609	802	0		29	10	S5609_802_0	3				1																																																																				
S5609	804	0		29	10	S5609_804_0	3				1																																																																				
S5609	805	0		29	10	S5609_805_0	3				1																																																																				
S5617	003	0		29	10	S5617_003_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	008	0		29	10	S5617_008_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	013	0		29	10	S5617_013_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	018	0		29	10	S5617_018_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	068	0		29	10	S5617_068_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	088	0		29	10	S5617_088_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	103	0		29	10	S5617_103_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	108	0		29	10	S5617_108_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	113	0		29	10	S5617_113_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	118	0		29	10	S5617_118_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	123	0		29	10	S5617_123_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	128	0		29	10	S5617_128_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	133	0		29	10	S5617_133_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	138	0		29	10	S5617_138_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	143	0		29	10	S5617_143_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	148	0		29	10	S5617_148_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	153	0		29	10	S5617_153_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	158	0		29	10	S5617_158_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	214	0		29	10	S5617_214_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	215	0		29	10	S5617_215_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	216	0		29	10	S5617_216_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	217	0		29	10	S5617_217_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	218	0		29	10	S5617_218_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	219	0		29	10	S5617_219_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	220	0		29	10	S5617_220_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	221	0		29	10	S5617_221_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	222	0		29	10	S5617_222_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	223	0		29	10	S5617_223_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	224	0		29	10	S5617_224_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	225	0		29	10	S5617_225_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	226	0		29	10	S5617_226_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	227	0		29	10	S5617_227_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	348	0		29	10	S5617_348_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5617	353	0		29	10	S5617_353_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	354	0		29	10	S5617_354_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	355	0		29	10	S5617_355_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	356	0		29	10	S5617_356_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	358	0		29	10	S5617_358_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	359	0		29	10	S5617_359_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	360	0		29	10	S5617_360_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	362	0		29	10	S5617_362_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	363	0		29	10	S5617_363_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	364	0		29	10	S5617_364_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	365	0		29	10	S5617_365_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	366	0		29	10	S5617_366_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	367	0		29	10	S5617_367_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	368	0		29	10	S5617_368_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	369	0		29	10	S5617_369_0	6			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	370	0		29	10	S5617_370_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	371	0		29	10	S5617_371_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	372	0		29	10	S5617_372_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	373	0		29	10	S5617_373_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	375	0		29	10	S5617_375_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	377	0		29	10	S5617_377_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	378	0		29	10	S5617_378_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	379	0		29	10	S5617_379_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	380	0		29	10	S5617_380_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	381	0		29	10	S5617_381_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	382	0		29	10	S5617_382_0	5			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	385	0		29	10	S5617_385_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan offers a preferred pharmacy benefit with lower cost share on select tiers.	1	3		0111110	3																																		1		1	1
S5617	801	0		29	10	S5617_801_0	3				1																																																																				
S5617	802	0		29	10	S5617_802_0	3				1																																																																				
S5617	805	0		29	10	S5617_805_0	3				1																																																																				
S5617	807	0		29	10	S5617_807_0	3				1																																																																				
S5660	801	0		29	10	S5660_801_0	1				1																																																																				
S5660	802	0		29	10	S5660_802_0	1				1																																																																				
S5660	803	0		29	10	S5660_803_0	1				1																																																																				
S5660	804	0		29	10	S5660_804_0	1				1																																																																				
S5660	814	0		29	10	S5660_814_0	1				1																																																																				
S5660	815	0		29	10	S5660_815_0	1				1																																																																				
S5715	001	0		29	10	S5715_001_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
S5715	005	0		29	10	S5715_005_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
S5715	010	0		29	10	S5715_010_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
S5715	012	0		29	10	S5715_012_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S5715	013	0		29	10	S5715_013_0	5			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S5715	014	0		29	10	S5715_014_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S5715	015	0		29	10	S5715_015_0	4			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S5715	020	0		29	10	S5715_020_0	4			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	101	This plan fulfills the requirement to increase the actuarial value of benefits, above the actuarial value of defined standard coverage, by offering reduced copays for certain formulary tiers and waiving the Part D deductible for Tiers 1 and 2. This is confirmed by the plan passing all alternative coverage tests on Worksheet 5 of the Part D Bid Pricing Tool (BPT).	2	3		0111100	1																																		1		1	1
S5715	801	0		29	10	S5715_801_0	1				1																																																																				
S5715	802	0		29	10	S5715_802_0	1				1																																																																				
S5715	803	0		29	10	S5715_803_0	1				1																																																																				
S5715	807	0		29	10	S5715_807_0	1				1																																																																				
S5715	809	0		29	10	S5715_809_0	1				1																																																																				
S5715	811	0		29	10	S5715_811_0	1				1																																																																				
S5715	813	0		29	10	S5715_813_0	1				1																																																																				
S5715	815	0		29	10	S5715_815_0	1				1																																																																				
S5715	817	0		29	10	S5715_817_0	1				1																																																																				
S5715	818	0		29	10	S5715_818_0	1				1																																																																				
S5715	819	0		29	10	S5715_819_0	1				1																																																																				
S5715	820	0		29	10	S5715_820_0	1				1																																																																				
S5715	821	0		29	10	S5715_821_0	1				1																																																																				
S5715	822	0		29	10	S5715_822_0	1				1																																																																				
S5715	823	0		29	10	S5715_823_0	1				1																																																																				
S5715	824	0		29	10	S5715_824_0	1				1																																																																				
S5715	825	0		29	10	S5715_825_0	1				1																																																																				
S5715	826	0		29	10	S5715_826_0	1				1																																																																				
S5715	827	0		29	10	S5715_827_0	1				1																																																																				
S5715	828	0		29	10	S5715_828_0	1				1																																																																				
S5715	829	0		29	10	S5715_829_0	1				1																																																																				
S5726	013	0		29	10	S5726_013_0	1			5F	1	3	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2					3		0111100	1																																		1		1	1
S5726	014	0		29	10	S5726_014_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	This plan offers a $0 deductible and reduced cost sharing compared to the defined standard prescription drug coverage.	1	3		0111100	1																																		1		1	1
S5726	020	0		29	10	S5726_020_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	2	0110000	1				2	1	001		1	3		0111100	1																																		1		1	1
S5726	805	0		29	10	S5726_805_0	1				1																																																																				
S5743	001	0		29	10	S5743_001_0	3			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111100																																			1		1	1
S5743	802	0		29	10	S5743_802_0	2				1																																																																				
S5743	805	0		29	10	S5743_805_0	2				1																																																																				
S5795	002	0		29	10	S5795_002_0	3			5F	1	4	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	$0 cost sharing for generics on Tier 1$5 cost sharing for drugs on Tier 220% coinsurance for drugs on Tier 3	2	3		0001110	1																																		1		1	1
S5795	003	0		29	10	S5795_003_0	3			5F	1	3	110100	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		1	615.00	1						2					3		0001110	1																																		1		1	1
S5795	804	0		29	10	S5795_804_0	2				1																																																																				
S5795	809	0		29	10	S5795_809_0	2				1																																																																				
S5795	811	0		29	10	S5795_811_0	2				1																																																																				
S5795	812	0		29	10	S5795_812_0	2				1																																																																				
S5805	803	0		29	10	S5805_803_0	1				1																																																																				
S5805	804	0		29	10	S5805_804_0	1				1																																																																				
S5805	807	0		29	10	S5805_807_0	1				1																																																																				
S5805	808	0		29	10	S5805_808_0	1				1																																																																				
S5805	809	0		29	10	S5805_809_0	1				1																																																																				
S5805	810	0		29	10	S5805_810_0	1				1																																																																				
S5805	811	0		29	10	S5805_811_0	1				1																																																																				
S5805	812	0		29	10	S5805_812_0	1				1																																																																				
S5805	813	0		29	10	S5805_813_0	1				1																																																																				
S5805	814	0		29	10	S5805_814_0	1				1																																																																				
S5805	815	0		29	10	S5805_815_0	1				1																																																																				
S5805	816	0		29	10	S5805_816_0	1				1																																																																				
S5805	818	0		29	10	S5805_818_0	1				1																																																																				
S5805	819	0		29	10	S5805_819_0	1				1																																																																				
S5805	820	0		29	10	S5805_820_0	1				1																																																																				
S5805	821	0		29	10	S5805_821_0	1				1																																																																				
S5805	822	0		29	10	S5805_822_0	1				1																																																																				
S5805	823	0		29	10	S5805_823_0	1				1																																																																				
S5805	824	0		29	10	S5805_824_0	1				1																																																																				
S5805	825	0		29	10	S5805_825_0	1				1																																																																				
S5805	826	0		29	10	S5805_826_0	1				1																																																																				
S5805	827	0		29	10	S5805_827_0	1				1																																																																				
S5805	828	0		29	10	S5805_828_0	1				1																																																																				
S5805	829	0		29	10	S5805_829_0	1				1																																																																				
S5805	830	0		29	10	S5805_830_0	1				1																																																																				
S5805	831	0		29	10	S5805_831_0	1				1																																																																				
S5805	832	0		29	10	S5805_832_0	1				1																																																																				
S5805	833	0		29	10	S5805_833_0	1				1																																																																				
S5805	834	0		29	10	S5805_834_0	1				1																																																																				
S5805	835	0		29	10	S5805_835_0	1				1																																																																				
S5805	836	0		29	10	S5805_836_0	1				1																																																																				
S5805	837	0		29	10	S5805_837_0	1				1																																																																				
S5805	838	0		29	10	S5805_838_0	1				1																																																																				
S5820	034	0		29	10	S5820_034_0	2				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
S5820	035	0		29	10	S5820_035_0	2				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
S5820	036	0		29	10	S5820_036_0	1				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
S5820	037	0		29	10	S5820_037_0	1				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
S5820	038	0		29	10	S5820_038_0	1				1	1	110110	1		2											615.00																110	30		90	01	30		110	30		90	1	31	2	2	35.00		105.00	35.00		105.00	35.00		35.00	25		25	25		25	25		25			1	1
S5820	803	0		29	10	S5820_803_0	1				1																																																																				
S5820	804	0		29	10	S5820_804_0	1				1																																																																				
S5820	807	0		29	10	S5820_807_0	1				1																																																																				
S5820	808	0		29	10	S5820_808_0	1				1																																																																				
S5820	810	0		29	10	S5820_810_0	1				1																																																																				
S5820	811	0		29	10	S5820_811_0	1				1																																																																				
S5820	812	0		29	10	S5820_812_0	1				1																																																																				
S5820	813	0		29	10	S5820_813_0	1				1																																																																				
S5820	814	0		29	10	S5820_814_0	1				1																																																																				
S5820	815	0		29	10	S5820_815_0	1				1																																																																				
S5820	816	0		29	10	S5820_816_0	1				1																																																																				
S5820	817	0		29	10	S5820_817_0	1				1																																																																				
S5820	818	0		29	10	S5820_818_0	1				1																																																																				
S5820	819	0		29	10	S5820_819_0	1				1																																																																				
S5820	820	0		29	10	S5820_820_0	1				1																																																																				
S5820	821	0		29	10	S5820_821_0	1				1																																																																				
S5820	822	0		29	10	S5820_822_0	1				1																																																																				
S5820	823	0		29	10	S5820_823_0	1				1																																																																				
S5820	824	0		29	10	S5820_824_0	1				1																																																																				
S5820	825	0		29	10	S5820_825_0	1				1																																																																				
S5820	826	0		29	10	S5820_826_0	1				1																																																																				
S5820	827	0		29	10	S5820_827_0	1				1																																																																				
S5820	828	0		29	10	S5820_828_0	1				1																																																																				
S5820	829	0		29	10	S5820_829_0	1				1																																																																				
S5820	830	0		29	10	S5820_830_0	1				1																																																																				
S5820	831	0		29	10	S5820_831_0	1				1																																																																				
S5820	832	0		29	10	S5820_832_0	1				1																																																																				
S5820	833	0		29	10	S5820_833_0	1				1																																																																				
S5820	834	0		29	10	S5820_834_0	1				1																																																																				
S5820	835	0		29	10	S5820_835_0	1				1																																																																				
S5820	836	0		29	10	S5820_836_0	1				1																																																																				
S5857	802	0		29	10	S5857_802_0	2				1																																																																				
S5857	803	0		29	10	S5857_803_0	2				1																																																																				
S5877	803	0		29	10	S5877_803_0	1				1																																																																				
S5877	804	0		29	10	S5877_804_0	1				1																																																																				
S5884	101	0		29	10	S5884_101_0	4			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	102	0		29	10	S5884_102_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	103	0		29	10	S5884_103_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	104	0		29	10	S5884_104_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	105	0		29	10	S5884_105_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	106	0		29	10	S5884_106_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	107	0		29	10	S5884_107_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	108	0		29	10	S5884_108_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	109	0		29	10	S5884_109_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	110	0		29	10	S5884_110_0	3			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	111	0		29	10	S5884_111_0	3			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	112	0		29	10	S5884_112_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	113	0		29	10	S5884_113_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	114	0		29	10	S5884_114_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	115	0		29	10	S5884_115_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	116	0		29	10	S5884_116_0	3			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	131	0		29	10	S5884_131_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	132	0		29	10	S5884_132_0	3			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	133	0		29	10	S5884_133_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	134	0		29	10	S5884_134_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	135	0		29	10	S5884_135_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	136	0		29	10	S5884_136_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	137	0		29	10	S5884_137_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	138	0		29	10	S5884_138_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	139	0		29	10	S5884_139_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	140	0		29	10	S5884_140_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	141	0		29	10	S5884_141_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	142	0		29	10	S5884_142_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	143	0		29	10	S5884_143_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	144	0		29	10	S5884_144_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	145	0		29	10	S5884_145_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	146	0		29	10	S5884_146_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	147	0		29	10	S5884_147_0	1			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	148	0		29	10	S5884_148_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	149	0		29	10	S5884_149_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	150	0		29	10	S5884_150_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	151	0		29	10	S5884_151_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	152	0		29	10	S5884_152_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	153	0		29	10	S5884_153_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	154	0		29	10	S5884_154_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	155	0		29	10	S5884_155_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	156	0		29	10	S5884_156_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	157	0		29	10	S5884_157_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	158	0		29	10	S5884_158_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	159	0		29	10	S5884_159_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	160	0		29	10	S5884_160_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	161	0		29	10	S5884_161_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	162	0		29	10	S5884_162_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	163	0		29	10	S5884_163_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	164	0		29	10	S5884_164_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	165	0		29	10	S5884_165_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	166	0		29	10	S5884_166_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	167	0		29	10	S5884_167_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	168	0		29	10	S5884_168_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	169	0		29	10	S5884_169_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	170	0		29	10	S5884_170_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	171	0		29	10	S5884_171_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	172	0		29	10	S5884_172_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	173	0		29	10	S5884_173_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	174	0		29	10	S5884_174_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	175	0		29	10	S5884_175_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	176	0		29	10	S5884_176_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	177	0		29	10	S5884_177_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	178	0		29	10	S5884_178_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	179	0		29	10	S5884_179_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	180	0		29	10	S5884_180_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	181	0		29	10	S5884_181_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	182	0		29	10	S5884_182_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	183	0		29	10	S5884_183_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	184	0		29	10	S5884_184_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	185	0		29	10	S5884_185_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	186	0		29	10	S5884_186_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	187	0		29	10	S5884_187_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	188	0		29	10	S5884_188_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	189	0		29	10	S5884_189_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	190	0		29	10	S5884_190_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	191	0		29	10	S5884_191_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	192	0		29	10	S5884_192_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	193	0		29	10	S5884_193_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	194	0		29	10	S5884_194_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	195	0		29	10	S5884_195_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	196	0		29	10	S5884_196_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	197	0		29	10	S5884_197_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	198	0		29	10	S5884_198_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	199	0		29	10	S5884_199_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	200	0		29	10	S5884_200_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	201	0		29	10	S5884_201_0	2			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	202	0		29	10	S5884_202_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	203	0		29	10	S5884_203_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	204	0		29	10	S5884_204_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	205	0		29	10	S5884_205_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	206	0		29	10	S5884_206_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	207	0		29	10	S5884_207_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	208	0		29	10	S5884_208_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	209	0		29	10	S5884_209_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	210	0		29	10	S5884_210_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	211	0		29	10	S5884_211_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	212	0		29	10	S5884_212_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	213	0		29	10	S5884_213_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	216	0		29	10	S5884_216_0	2			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5884	217	0		29	10	S5884_217_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		3								2	1	110	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	1	3		0111110	1																																		1		1	1
S5884	218	0		29	10	S5884_218_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	601.00	2	0110000	1				2	1	111	The enhanced benefits satisfy all the BPT requirements around actuarial value. Benefit enhancements are achieved through a combination of enhancements relative to defined standard which could include: reduced Initial Coverage Phase cost sharing, reduced deductible, deductible tier exclusions, and/or reduced insulin cost sharing.	2	3		0111110	1																																		1		1	1
S5884	834	0		29	10	S5884_834_0	2				1																																																																				
S5884	837	0		29	10	S5884_837_0	2				1																																																																				
S5884	838	0		29	10	S5884_838_0	1				1																																																																				
S5904	001	0		29	10	S5904_001_0	6			5F4	1	3	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0000001	1				2					3		0001110	1																																		1		1	1
S5904	002	0		29	10	S5904_002_0	7			5F4	1	4	110110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0110001	1				2	1	101	The requirement is fulfilled by passing the tests for alternative coverage on worksheet 5 of the BPT. We project the benefit to have a paid to allowed ratio greater than the paid to allowed ratio under the defined standard benefit.	2	3		0001110	1																																		1		1	1
S5904	801	0		29	10	S5904_801_0	2				1																																																																				
S5904	802	0		29	10	S5904_802_0	2				1																																																																				
S5916	802	0		29	10	S5916_802_0	3				1																																																																				
S5916	804	0		29	10	S5916_804_0	3				1																																																																				
S5916	805	0		29	10	S5916_805_0	3				1																																																																				
S5921	348	0		29	10	S5921_348_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	349	0		29	10	S5921_349_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	350	0		29	10	S5921_350_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	351	0		29	10	S5921_351_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	352	0		29	10	S5921_352_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	353	0		29	10	S5921_353_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	354	0		29	10	S5921_354_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	355	0		29	10	S5921_355_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	356	0		29	10	S5921_356_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	357	0		29	10	S5921_357_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	358	0		29	10	S5921_358_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	359	0		29	10	S5921_359_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	360	0		29	10	S5921_360_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	361	0		29	10	S5921_361_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	362	0		29	10	S5921_362_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	363	0		29	10	S5921_363_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	364	0		29	10	S5921_364_0	1			5F	1	2	101110	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	365	0		29	10	S5921_365_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	366	0		29	10	S5921_366_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	367	0		29	10	S5921_367_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	368	0		29	10	S5921_368_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	369	0		29	10	S5921_369_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	370	0		29	10	S5921_370_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	371	0		29	10	S5921_371_0	2			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	372	0		29	10	S5921_372_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	373	0		29	10	S5921_373_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	374	0		29	10	S5921_374_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	375	0		29	10	S5921_375_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	376	0		29	10	S5921_376_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	377	0		29	10	S5921_377_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	378	0		29	10	S5921_378_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	379	0		29	10	S5921_379_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	380	0		29	10	S5921_380_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	381	0		29	10	S5921_381_0	1			5F	1	2	101101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0001110																																			1		1	1
S5921	382	0		29	10	S5921_382_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	383	0		29	10	S5921_383_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	384	0		29	10	S5921_384_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	385	0		29	10	S5921_385_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	386	0		29	10	S5921_386_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	387	0		29	10	S5921_387_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	388	0		29	10	S5921_388_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	389	0		29	10	S5921_389_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	390	0		29	10	S5921_390_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	391	0		29	10	S5921_391_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	392	0		29	10	S5921_392_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	393	0		29	10	S5921_393_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	394	0		29	10	S5921_394_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	395	0		29	10	S5921_395_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	396	0		29	10	S5921_396_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	397	0		29	10	S5921_397_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	398	0		29	10	S5921_398_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	399	0		29	10	S5921_399_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	400	0		29	10	S5921_400_0	1			5F	1	4	101110	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	401	0		29	10	S5921_401_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	402	0		29	10	S5921_402_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	403	0		29	10	S5921_403_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	404	0		29	10	S5921_404_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	405	0		29	10	S5921_405_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	406	0		29	10	S5921_406_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	407	0		29	10	S5921_407_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	408	0		29	10	S5921_408_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	409	0		29	10	S5921_409_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	410	0		29	10	S5921_410_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	411	0		29	10	S5921_411_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	412	0		29	10	S5921_412_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	413	0		29	10	S5921_413_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	414	0		29	10	S5921_414_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	415	0		29	10	S5921_415_0	1			5F	1	4	101101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	130.00	2	0110000	1				2	1	111	Members have a reduced deductible below the standard benefit, Member's deductible only applies to Tiers 3, 4, and 5, Members pay copays instead of coinsurance on tiers 1 and 2, and Member has coverage of some excluded drugs.	1	3		0001110	3																																		1		1	1
S5921	802	0		29	10	S5921_802_0	1				1																																																																				
S5921	837	0		29	10	S5921_837_0	1				1																																																																				
S5921	890	0		29	10	S5921_890_0	1				1																																																																				
S5921	891	0		29	10	S5921_891_0	1				1																																																																				
S5921	892	0		29	10	S5921_892_0	1				1																																																																				
S5921	893	0		29	10	S5921_893_0	1				1																																																																				
S5921	894	0		29	10	S5921_894_0	1				1																																																																				
S5953	001	0		29	10	S5953_001_0	3			5F4	1	3	101110	1	2	2		6	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs		1	615.00	2	0100001	1				2					3		0001110	1																																		1		1	1
S5953	801	0		29	10	S5953_801_0	2				1																																																																				
S5953	802	0		29	10	S5953_802_0	2				1																																																																				
S5960	803	0		29	10	S5960_803_0	1				1																																																																				
S5960	804	0		29	10	S5960_804_0	1				1																																																																				
S5960	805	0		29	10	S5960_805_0	1				1																																																																				
S5966	803	0		29	10	S5966_803_0	2				1																																																																				
S5966	804	0		29	10	S5966_804_0	2				1																																																																				
S5975	801	0		29	10	S5975_801_0	1				1																																																																				
S5975	807	0		29	10	S5975_807_0	1				1																																																																				
S5975	808	0		29	10	S5975_808_0	1				1																																																																				
S5975	810	0		29	10	S5975_810_0	1				1																																																																				
S5993	001	0		29	10	S5993_001_0	5			5F	1	2	110101	1		2		5	4	2		2	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1		615.00														0111110																																			1		1	1
S5993	003	0		29	10	S5993_003_0	6			5F	1	4	110101	1	2	2		5	4	2				Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier		2	200.00	2	0110000	1				2	1	111	This plan has a $200 deductible for Tiers 3,4,5 and has low generic copays rather than 25% coinsurance.	2	3		0111110	1																																		1		1	1
S5993	801	0		29	10	S5993_801_0	1				1																																																																				
S5993	804	0		29	10	S5993_804_0	1				1																																																																				
S5993	806	0		29	10	S5993_806_0	1				1																																																																				
S6875	801	0		29	10	S6875_801_0	3				1																																																																				
S6875	802	0		29	10	S6875_802_0	3				1																																																																				
S6939	801	0		29	10	S6939_801_0	1				1																																																																				
S8067	801	0		29	10	S8067_801_0	1				1																																																																				
S8067	803	0		29	10	S8067_803_0	1				1																																																																				
S8067	804	0		29	10	S8067_804_0	1				1																																																																				
S8067	805	0		29	10	S8067_805_0	1				1																																																																				
S8067	806	0		29	10	S8067_806_0	1				1																																																																				
S8067	807	0		29	10	S8067_807_0	1				1																																																																				
S8067	808	0		29	10	S8067_808_0	1				1																																																																				
S8841	803	0		29	10	S8841_803_0	1				1																																																																				
S8841	804	0		29	10	S8841_804_0	1				1																																																																				
S8841	807	0		29	10	S8841_807_0	1				1																																																																				
S8841	808	0		29	10	S8841_808_0	1				1																																																																				
S8841	810	0		29	10	S8841_810_0	1				1																																																																				
S8841	812	0		29	10	S8841_812_0	1				1																																																																				
S8841	813	0		29	10	S8841_813_0	1				1																																																																				
S8841	818	0		29	10	S8841_818_0	1				1																																																																				
S8841	819	0		29	10	S8841_819_0	1				1																																																																				
S8841	820	0		29	10	S8841_820_0	1				1																																																																				
S8841	821	0		29	10	S8841_821_0	1				1																																																																				
S8841	822	0		29	10	S8841_822_0	1				1																																																																				
S9701	801	0		29	10	S9701_801_0	1				1																																																																				
S9701	802	0		29	10	S9701_802_0	1				1																																																																				
S9701	803	0		29	10	S9701_803_0	1				1																																																																				
S9701	804	0		29	10	S9701_804_0	1				1																																																																				
S9701	807	0		29	10	S9701_807_0	1				1																																																																				
S9701	808	0		29	10	S9701_808_0	1				1																																																																				
