PBP_A_HNUMBER	PBP_A_PLAN_IDENTIFIER	PBP_A_BEN_COV	PBP_A_PLAN_TYPE	ORGTYPE	PBP_B13A_BENDEC_YESNO	PBP_B13A_BENDEC	PBP_B13A_BENDESC_AMO	PBP_B13A_MAXENR_YESNO	PBP_B13A_MAXENR_AMT	PBP_B13A_MAXENR_PER	PBP_B13A_COINS_YESNO	PBP_B13A_COINS_PCT_MC	PBP_B13A_COINS_COV_MC	PBP_B13A_DED_YESNO	PBP_B13A_DED_AMT	PBP_B13A_COPAY_YESNO	PBP_B13A_COPAY_MC_AMT	PBP_B13A_AUTH	PBP_B13A_MAXPLAN_YESNO_POS	PBP_B13A_MAXPLN_AMT_POS	PBP_B13A_MAXPLN_PER_POS	PBP_B13A_MAXPLN_COV_POS	PBP_B13A_MAXENR_YN_POS	PBP_B13A_MAXENR_AMT_POS	PBP_B13A_COINS_YESNO_POS	PBP_B13A_COINS_PCT_POS	PBP_B13A_COINS_COV__POS	PBP_B13A_DED_YESNO_POS	PBP_B13A_DED_AMT_POS	PBP_B13A_COPAY_YESNO_POS	PBP_B13A_COPAY_AMT_POS	PBP_B13A_AUTH_POS	PBP_B13B_BENDESC_YESNO	PBP_B13B_BENDESC_ENHAN	PBP_B13B_BENDESC_AMO	PBP_B13B_BENDESC_LIM	PBP_B13B_BENDESC_NUMV	PBP_B13B_BENDESC_PER	PBP_B13B_MAXPLAN_YESNO	PBP_B13B_MAXPLAN_AMT	PBP_B13B_MAXPLAN_PER	PBP_B13B_MAXPLAN_COV	PBP_B13B_MAXENR_YESNO	PBP_B13B_MAXENR_AMT	PBP_B13B_MAXENR_PER	PBP_B13B_COINS_YESNO	PBP_B13B_COINS_PCT	PBP_B13B_COINS_COV	PBP_B13B_DED_YESNO	PBP_B13B_DED_AMT	PBP_B13B_COPAY_YESNO	PBP_B13B_COPAY_AMT	PBP_B13B_AUTH	PBP_B13B_MAXPLAN_YESNO_POS	PBP_B13B_MAXPLN_AMT_POS	PBP_B13B_MAXPLN_PER_POS	PBP_B13B_MAXPLN_COV_POS	PBP_B13B_MAXENR_YESNO_POS	PBP_B13B_MAXENR_AMT_POS	PBP_B13B_COINS_YESNO_POS	PBP_B13B_COINS_PCT_POS	PBP_B13B_COINS_COV__POS	PBP_B13B_DED_YESNO_POS	PBP_B13B_DED_AMT_POS	PBP_B13B_COPAY_YESNO_POS	PBP_B13B_COPAY_AMT_POS	PBP_B13B_AUTH_POS	PBP_B13C_BENDESC_SERVICE	PBP_B13C_BENDESC_AMO	PBP_B13C_MAXPLAN_YESNO	PBP_B13C_MAXPLAN_AMT	PBP_B13C_MAXPLAN_PER	PBP_B13C_MAXPLAN_COV	PBP_B13C_MAXENR_YESNO	PBP_B13C_MAXENR_AMT	PBP_B13C_MAXENR_PER	PBP_B13C_COINS_YESNO	PBP_B13C_COINS_PCT	PBP_B13C_COINS_COV	PBP_B13C_DED_YESNO	PBP_B13C_DED_AMT	PBP_B13C_COPAY_YESNO	PBP_B13C_COPAY_AMT	PBP_B13C_AUTH	PBP_B13C_MAXPLAN_YESNO_POS	PBP_B13C_MAXPLN_AMT_POS	PBP_B13C_MAXPLN_PER_POS	PBP_B13C_MAXPLN_COV_POS	PBP_B13C_MAXENR_YESNO_POS	PBP_B13C_MAXENR_AMT_POS	PBP_B13C_COINS_YESNO_POS	PBP_B13C_COINS_PCT_POS	PBP_B13C_COINS_COV__POS	PBP_B13C_DED_YESNO_POS	PBP_B13C_DED_AMT_POS	PBP_B13C_COPAY_YESNO_POS	PBP_B13C_COPAY_AMT_POS	PBP_B13C_AUTH_POS	PBP_B13D_BENDESC_SERVICE	PBP_B13D_BENDESC_AMO	PBP_B13D_MAXPLAN_YESNO	PBP_B13D_MAXPLAN_AMT	PBP_B13D_MAXPLAN_PER	PBP_B13D_MAXPLAN_COV	PBP_B13D_MAXENR_YESNO	PBP_B13D_MAXENR_AMT	PBP_B13D_MAXENR_PER	PBP_B13D_COINS_YESNO	PBP_B13D_COINS_PCT	PBP_B13D_COINS_COV	PBP_B13D_DED_YESNO	PBP_B13D_DED_AMT	PBP_B13D_COPAY_YESNO	PBP_B13D_COPAY_AMT	PBP_B13D_AUTH	PBP_B13D_MAXPLAN_YESNO_POS	PBP_B13D_MAXPLN_AMT_POS	PBP_B13D_MAXPLN_PER_POS	PBP_B13D_MAXPLN_COV_POS	PBP_B13D_MAXENR_YESNO_POS	PBP_B13D_MAXENR_AMT_POS	PBP_B13D_COINS_YESNO_POS	PBP_B13D_COINS_PCT_POS	PBP_B13D_COINS_COV__POS	PBP_B13D_DED_YESNO_POS	PBP_B13D_DED_AMT_POS	PBP_B13D_COPAY_YESNO_POS	PBP_B13D_COPAY_AMT_POS	PBP_B13D_AUTH_POS	PBP_B13E_BENDESC_SERVICE	PBP_B13E_BENDESC_AMO	PBP_B13E_MAXPLAN_YESNO	PBP_B13E_MAXPLAN_AMT	PBP_B13E_MAXPLAN_PER	PBP_B13E_MAXPLAN_COV	PBP_B13E_MAXENR_YESNO	PBP_B13E_MAXENR_AMT	PBP_B13E_MAXENR_PER	PBP_B13E_COINS_YESNO	PBP_B13E_COINS_PCT	PBP_B13E_COINS_COV	PBP_B13E_DED_YESNO	PBP_B13E_DED_AMT	PBP_B13E_COPAY_YESNO	PBP_B13E_COPAY_AMT	PBP_B13E_AUTH	PBP_B13E_MAXPLAN_YESNO_POS	PBP_B13E_MAXPLN_AMT_POS	PBP_B13E_MAXPLN_PER_POS	PBP_B13E_MAXPLN_COV_POS	PBP_B13E_MAXENR_YESNO_POS	PBP_B13E_MAXENR_AMT_POS	PBP_B13E_COINS_YESNO_POS	PBP_B13E_COINS_PCT_POS	PBP_B13E_COINS_COV__POS	PBP_B13E_DED_YESNO_POS	PBP_B13E_DED_AMT_POS	PBP_B13E_COPAY_YESNO_POS	PBP_B13E_COPAY_AMT_POS	PBP_B13E_AUTH_POS
H0150	001	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H0151	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H0151	002	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H0151	003	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H0154	001	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Sports Fitness	1	1	20	6	5	2			2			2		2		10000															Parking for Medical Services	1	2				2			2			2		1	0	01000																																													
H0154	002	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Sports Fitness	1	1	20	6	5	2			2			2		2		10000															Parking for Medical Services	1	2				2			2			2		1	0	01000																																													
H0302	001	1	01	01	1	1	2	2			2			2		2		00110															2																																			Personal Travel Benefit	2	1	1000	3	4	2			2			2		1	5	00101																																																																												
H0302	002	1	01	01	1	1	2	2			2			2		2		00110															2																																			Personal Travel Benefit	2	1	1000	3	4	2			2			2		1	5	00101															Personal Services Care	2	2				2			2			2		2		00001																																													
H0303	013	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recivery	1	1	50	6	5	2			2			2		2		01000														
H0303	014	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	2	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	2	1	50	6	5	2			2			2		2		01000														
H0303	015	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	1	1	50	6	5	2			2			2		2		01000														
H0303	016	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	1	1	50	6	5	2			2			2		2		01000														
H0303	021	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	2	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	2	1	50	6	5	2			2			2		2		01000														
H0303	022	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	2	1	50	6	5	2			2			2		2		01000														
H0303	023	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	2	1	50	6	5	2			2			2		2		01000														
H0303	024	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	1	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	1	1	50	6	5	2			2			2		2		01000														
H0303	033	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (excluding Insulin)	2	2				2			2			2		1	75	00110															Dental Silver Plan	3	2				2			2			2		1	10	01000															In-Home Recovery	2	1	50	6	5	2			2			2		2		01000														
H0307	004	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	350	5	5	2			1	25	5	2		1	0	10000															Immediate care facility	1	2				2			2			2		1	25	01000																																													
H0307	007	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																		Immediate Care Facility	1	2				2			2			2		1	25	01000																																													
H0350	001	1	01	01	2			2			2			2		2		01000															2																																																																																																																															
H0351	007	1	01	01	1	1	1	2			2			2		1	0	00111															2																																																																																																																															
H0351	008	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0351	014	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0351	016	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																																																																															
H0351	017	2	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0351	021	2	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0351	023	1	01	01	1	1	1	2			2			2		1	0	00111															2																																																																																																																															
H0354	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H0354	009	2	01	01	2			2			2			2		2		00111															2																																																																																																																															
H0359	002	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0451	001	1	01	01	1	1	2	2			2			2		2		01000															2																																			Nurse Triage Service	2	2				2			2			2		2		01000																																																																												
H0451	002	1	01	01	1	1	2	2			2			2		2		01000															2																																			Nurse Triage Service	2	2				2			2			2		2		01000																																																																												
H0455	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H0455	002	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H0504	005	1	01	01	1	1	1	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	1	2				2			2			2		1	25	00111																																																																												
H0504	006	1	01	01	1	1	2	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	2	2				2			2			2		1	25	00111															Care Package (Part 1)	2	2				2			2			2		1	5	00111															Care Package (Part 2)	2	2				2			2			2		2		00111														
H0504	007	1	01	01	1	1	1	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	1	2				2			2			2		1	25	00111															Care Package (Part 1)	1	2				2			2			2		1	5	00111															Care Package (Part 2)	1	2				2			2			2		2		00111														
H0504	009	1	01	01	1	1	2	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	2	2				2			2			2		1	25	00111																																																																												
H0504	010	1	01	01	1	1	2	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	2	2				2			2			2		1	25	00111																																																																												
H0504	013	1	01	01	1	1	2	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	2	2				2			2			2		1	25	00111																																																																												
H0504	014	1	01	01	1	1	2	2			2			2		2		00111															1	1	3	2	20	3	2				2			2			2		1	10	01000															Diaphragms and their fitting	2	2				2			2			2		1	25	00111															Care Package (Part 1)	2	2				2			2			2		1	5	00111															Care Package (Part 2)	2	2				2			2			2		2		00111														
H0523	001	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	002	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	004	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	005	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	021	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	022	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	023	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0523	024	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0524	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0524	002	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0524	003	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0526	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0526	002	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0532	001	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0532	002	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0543	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	15	00100																																																																												
H0543	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	20	00100																																																																												
H0543	007	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	20	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	010	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	013	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	20	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	016	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	25	00100																																																																												
H0543	019	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	25	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	022	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	025	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	026	2	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	027	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	028	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	029	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	030	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	031	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	30	00100																																																																												
H0543	032	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	033	2	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	034	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	30	00100																																																																												
H0543	035	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	036	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	037	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	038	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	039	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	040	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	30	00100																																																																												
H0543	041	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	042	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	043	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	046	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	047	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	048	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	15	00100																																																																												
H0543	049	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	20	00100																																																																												
H0543	050	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	20	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	051	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	20	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	053	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	054	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	056	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100															Optional Dental Plan	3	2				2			2			2		1	15	10000																																													
H0543	057	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables	2	2				2			2			2		1	30	00100																																																																												
H0543	059	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Outpatient Injectables	1	2				2			2			2		1	30	00100																																																																												
H0545	001	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H0545	002	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H0545	003	2	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H0545	004	2	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H0562	002	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	009	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	010	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	011	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	012	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	013	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	014	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	017	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	018	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	019	2	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	028	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	029	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	030	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	031	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0562	032	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	033	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	034	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	035	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0562	036	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	037	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	038	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H0562	039	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H0564	003	1	02	01	1	1	2	2			2			2		1	0	10100															2																																																																																																																															
H0564	004	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	005	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	006	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	007	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	008	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	009	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	010	1	02	01	1	1	1	2			2			2		2		10100															2																																																																																																																															
H0564	011	1	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	014	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	015	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	016	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	017	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	018	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	019	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0564	022	2	02	01	1	1	2	2			2			2		2		10100															2																																																																																																																															
H0566	003	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0566	004	2	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0568	004	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0568	006	2	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H0571	001	1	01	01	1	1	1	2			2			2		2		01000															1	1	1	1			2				2			2			2		1	5	00111																																																																																																											
H0571	002	2	01	01	1	1	1	2			2			2		2		01000															1	1	1	1			2				2			2			2		1	5	00111																																																																																																											
H0583	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0583	002	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0583	003	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0584	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0584	003	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Abortion	2	2				2			2			2		1	10	00110																																																																												
H0603	006	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Optional Inpatient Hospital / Psych Services	3	2				2			2			2		1	150	00110															Optional Hospital Outpatient Services	3	2				2			2			2		1	50	00110															Optional Diagnostic & Preventive Office Visits -- PCP	3	2				2			2			2		1	10	00110														
H0609	001	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10111																																																																												
H0609	002	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10110																																																																												
H0609	003	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10110																																																																												
H0609	006	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10110																																																																												
H0609	007	1	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10110																																																																												
H0609	008	2	01	01	1	1	2	2			2			2		1	0	00110															2																																			Outpatient Injectables (Excluding Insulin)	2	2				2			2			2		1	250	10110																																																																												
H0630	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H0630	005	1	02	01	1	1	1	2			2			2		1	0	00110															2																																			Travel Benefit	2	2				2			1	20	4	2		2		01000	2				2		1	20	4	2		2		01000																																																														
H0630	006	1	02	01	1	1	1	2			2			2		1	0	00110															2																																			Travel Benefit	2	2				2			1	20	4	2		2		01000	2				2		1	20	4	2		2		01000																																																														
H0630	007	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H0630	008	2	02	01	1	1	1	2			2			2		1	0	00110															2																																			Travel Benefit	2	2				2			1	20	4	2		2		01000	2				2		1	20	4	2		2		01000																																																														
H0630	009	2	02	01	1	1	1	2			2			2		1	0	00110															2																																			Travel Benefit	1	2				2			1	20	4	2		2		01000	2				2		1	20	4	2		2		01000																																																														
H0752	002	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0754	003	1	01	01	1	1	2	2			2			2		2		00110															2																																																																																																																															
H0754	005	1	01	01	1	1	2	2			2			2		2		00110															2																																																																																																																															
H0754	006	1	01	01	1	1	2	2			2			2		2		00110															2																																																																																																																															
H0755	001	1	01	01	1	1	2	2			2			2		1	0	00001															2																																																																																																																															
H0755	007	2	01	01	1	1	2	2			2			2		1	0	00001															2																																																																																																																															
H0759	001	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0759	002	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0759	003	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0759	004	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0759	005	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0759	006	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H0802	001	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H0803	001	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H0954	002	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H0954	003	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H0954	004	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H0954	008	2	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1013	002	1	01	01	1	1	1	2			2			2		2		00111															2																																			Over the Counter Benefit Program	1	1	15	6	2	2			2			2		2		01000																																																																												
H1013	005	1	01	01	1	1	1	2			2			2		2		00111															2																																			Over the Counter Benefit Program	1	1	15	6	2	2			2			2		2		01000																																																																												
H1013	006	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H1013	007	2	01	01	1	1	1	2			2			2		2		00111															2																																			Over the Counter Benefit Program	1	1	15	6	2	2			2			2		2		01000																																																																												
H1013	008	2	01	01	1	1	1	2			2			2		2		00111															2																																			Over the Counter Benefit Program	1	1	15	6	2	2			2			2		2		01000																																																																												
H1013	009	2	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H1016	001	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H1016	002	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H1016	003	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H1016	006	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	007	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	008	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	009	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	010	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	011	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	012	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	013	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	014	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	015	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	016	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1016	017	2	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1019	001	1	01	01	1	1	1	2			2			1	0	1	0	00001															1	1	1	1			2				2			2			2		2		01000															Emergency Response System	1	2				2			2			2		1	25	10000																																																																												
H1019	002	1	01	01	1	1	1	2			2			1	0	1	0	00001															1	1	1	1			2				2			2			2		1	0	10000															Emergency Response System	1	2				2			2			2		1	25	10000																																																																												
H1026	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Shot	2	2				2			2			2		1	5	00110															Over the Counter Drug	2	1	20	5	3	2			2			2		1	0	01000																																													
H1026	002	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Shot	2	2				2			2			2		1	5	00110															Over the Counter Drug	2	1	20	5	3	2			2			2		1	0	01000																																													
H1026	003	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H1026	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Injection	2	2				2			2			2		1	5	00100																																																																												
H1026	008	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Shot	2	2				2			2			2		1	5	00110															Over the Counter Drug	2	1	20	5	3	2			2			2		1	0	01000																																													
H1026	009	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Shot	2	2				2			2			2		1	5	00110															Over the Counter Drug	2	1	20	5	3	2			2			2		1	0	01000																																													
H1026	011	2	01	01	1	1	1	2			2			2		1	0	00110															2																																			Allergy Injection	2	2				2			2			2		1	5	00100																																																																												
H1027	001	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H1027	002	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H1027	003	1	01	01	2			2			2			2		1	0	00111															2																																			Over the Counter Drugs	1	1	15	6	1	2			2			2		1	0	01000																																																																												
H1032	002	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	003	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	004	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	005	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	006	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	007	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	008	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	009	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	010	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	011	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	012	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	013	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	014	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	015	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	019	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	020	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	021	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1032	022	1	01	01	2			2			2			2		1	0	00110															2																																																																																																																															
H1034	001	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H1034	002	1	01	01	1	1	2	2			2			2		2		00110															2																																																																																																																															
H1034	003	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H1035	002	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H1035	004	2	01	01	2			2			2			2		2		00110															2																																																																																																																															
H1036	011	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	150	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	0	00111																																													
H1036	014	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	016	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	50	6	5	2			1	25	5	2		1	0	10000																																																																												
H1036	020	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	85	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	025	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self-administered injectable drugs	1	2				2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	20	00111																																													
H1036	032	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	50	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	20	00111																																													
H1036	034	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	2				2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	0	00111																																													
H1036	035	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	100	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	0	00111																																													
H1036	037	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	50	6	5	2			1	25	5	2		1	0	10000															Immediate care facility	1	2				2			2			2		1	30	00111																																													
H1036	038	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	040	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self-administered injectable drugs	1	2				2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	20	00111																																													
H1036	041	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	50	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	20	00111																																													
H1036	042	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	044	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High Technology Drugs	1	1	50	6	5	2			1	25	5	2		1	0	10000																																																																												
H1036	047	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	048	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	050	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	45	6	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1036	051	2	01	01	1	1	1	2			2			2		1	0	00111															2																																			Immediate Care Facility	1	2				2			2			2		1	30	00111																																																																												
H1071	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1071	002	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1076	001	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H1076	002	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H1076	003	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H1076	006	2	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H1076	007	2	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H1076	008	2	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H1078	001	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Vitamins per Calendar Quarter	1	1	15	5	3	2			2			2		1	0	01000																																																																												
H1078	002	2	01	01	1	1	1	2			2			2		1	0	00111															2																																			Vitamins Every Calendar Quarter	1	1	15	5	3	2			2			2		1	0	01000																																																																												
H1078	003	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Vitamins per Calendar Quarter	1	1	15	5	3	2			2			2		1	0	01000																																																																												
H1078	004	2	01	01	1	1	1	2			2			2		1	0	00111															2																																			Vitamins Every Calendar Quarter	1	1	15	5	3	2			2			2		1	0	01000																																																																												
H1078	005	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Vitamins per Calendar Quarter	1	1	15	5	3	2			2			2		1	0	01000																																																																												
H1080	004	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H1080	007	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H1080	008	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H1080	011	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H1082	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	002	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	005	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	006	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	007	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	008	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1082	009	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H1099	001	1	01	01	1	1	1	2			2			2		1	0	00111															2																																																																																																																															
H1106	001	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H1168	004	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H1170	002	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H1170	005	2	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H1230	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1230	002	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H1252	001	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H1350	001	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H1406	006	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	100	5	5	2			1	25	5	2		1	0	10000																																																																												
H1406	007	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	150	5	5	2			1	25	5	2		1	0	10000																																																																												
H1406	013	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000																																																																												
H1406	014	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	100	5	5	2			1	25	5	2		1	0	10000																																																																												
H1406	015	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000																																																																												
H1406	016	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	100	5	5	2			1	25	5	2		1	0	10000																																																																												
H1406	017	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000																																																																												
H1406	019	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																																																																															
H1463	001	1	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H1468	001	1	01	01	2			2			2			2		2		01000															2																																																																																																																															
H1506	001	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H1750	005	1	01	01	1	1	2	2			2			2		1	0	00100															2																																			Home IV Drugs	2	2				2			2			2		1	0	00101																																																																												
H1750	006	1	01	01	1	1	2	2			2			2		1	0	00100															2																																			Home IV Drugs	2	2				2			2			2		1	0	00101																																																																												
H1751	002	1	02	01	1	1	1	2			2			2		2		00110															2																																			Travel Benefit	3	2				2			2			2		2		01000	2				2		1	20	4	2		2		01000																																																														
H1751	004	2	02	01	1	1	1	2			2			2		2		00110															2																																			Travel Benefit	3	2				2			2			2		2		01000	2				2		1	20	4	2		2		01000																																																														
H1849	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1849	002	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H1890	003	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1890	005	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	175	5	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1890	008	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																		Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H1951	001	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Diabetes Education	1	2				2			2			2		1	10	00111															Back Exercise Education	1	2				2			2			2		1	10	00111																																													
H1958	001	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H1958	003	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H1961	001	1	02	01	1	1	1	2			2			2		1	0	00101	2				2		1	20	4	1	100	2		00001	2																																			Organ Transplants	1	2				2			2			2		1	0	00101																																																																												
H1964	006	1	01	01	2			2			2			2		2		00100															2																																			Transplants	1	2				2			2			2		1	1500	00100																																																																												
H2108	001	1	01	01	2			2			1	20	4	2		2		00001															2																																			NURSE PRACTICIONER OFFICE VISITS	1	2				1	0	6	2			2		2		00001															massage therapy	1	1	1	6	2	1	0	6	2			2		2		00001															hair salon service	1	1	1	6	2	1	0	6	2			2		2		00001														
H2108	002	1	01	01	2			2			1	20	4	2		2		00001															2																																			NURSE PRACTICIONER OFFICE VISITS	1	2				1	0	6	2			2		2		00001															massage therapy	1	1	1	6	2	1	0	6	2			2		2		00001															hair salon service	1	1	1	6	2	1	0	6	2			2		2		00001														
H2204	007	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H2206	003	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H2206	013	2	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H2256	001	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H2256	002	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H2256	005	2	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H2256	006	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H2256	007	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H2261	005	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H2261	006	2	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H2261	007	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H2261	008	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H2312	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2350	001	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2350	002	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2350	004	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2350	005	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2350	008	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2350	009	1	01	01	2			2			2			2		2		00100															2																																																																																																																															
H2353	001	1	01	01	1	1	1	2			2			2		1	0	00101															2																																																																																																																															
H2353	004	1	01	01	1	1	1	2			2			2		1	0	00101															2																																			Outpatient Blood Transfusions	1	2				2			2			2		2		00101																																																																												
H2353	005	2	01	01	1	1	2	2			2			2		1	0	00101															2																																																																																																																															
H2354	001	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H2354	007	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H2354	008	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H2354	009	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H2354	010	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H2354	011	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H2357	001	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H2357	002	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H2403	002	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H2403	003	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H2406	001	1	04	01	1	1	1	2			2			2		1	0	10000															2																																			Transplant Services	1	2				2			2			2		1	1500	10000																																																																												
H2459	001	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H2459	002	1	02	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H2502	001	1	01	01	2			2			2			2		2		00101															2																																																																																																																															
H2649	004	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	188	5	5	2			1	25	5	2		1	0	10000															Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	20	00111														
H2649	005	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	225	5	5	2			1	25	5	2		1	0	10000															Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	12	00111														
H2649	006	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	188	5	5	2			1	25	5	2		1	0	10000															Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	20	00111														
H2649	007	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000															Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	20	00111														
H2649	008	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			Self administered injectable drugs	1	2				2			1	25	5	2		1	0	10000															Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	20	00111														
H2649	009	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																		Physician administered injectable drugs	1	2				2			2			2		1	4	00111															Personal Home Care	1	2				2			2			2		1	20	00111														
H2652	001	1	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H2652	002	1	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H2652	004	1	01	01	1	1	2	2			2			2		2		00100															2																																																																																																																															
H2654	003	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2654	004	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2654	005	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2654	006	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2654	007	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2663	001	1	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H2663	002	1	01	01	1	1	2	2			2			2		2		00100															2																																																																																																																															
H2663	003	2	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H2663	004	1	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H2666	004	1	01	01	1	1	1	2			2			2		1	0	00001															2																																																																																																																															
H2667	001	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	002	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	003	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	005	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	006	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2667	007	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2672	001	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H2802	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H2931	002	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H2931	003	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H2931	004	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H2931	005	1	01	01	2			2			2			2		2		00101															2																																																																																																																															
H2931	006	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H2931	007	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H2931	008	2	02	01	2			2			2			2		2		00111															2																																																																																																																															
H2949	002	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2949	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H2949	005	2	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H2960	001	1	02	01	2			2			1	20	4	2		2		01000															2																																																																																																																															
H2960	002	1	02	01	2			2			1	20	4	2		2		01000															2																																																																																																																															
H3107	001	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H3107	003	2	01	01	2			2			2			2		2		00001															2																																																																																																																															
H3152	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3152	022	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3152	029	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3154	001	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3154	002	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3156	021	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3156	022	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3164	001	1	01	01	1	1	1	2			2			2		2		00100															2																																			Adult Day Care	1	1	500	3	5	2			2			2		1	15	00001															Personal Medical Emergency Response System	1	1	300	3	5	2			2			2		1	20	00001															Home Assessment and Adaptation Services	1	1	200	3	5	2			2			2		2		00001														
H3204	001	1	01	01	2			2			2			2		2		00111															2																																			Discount Dental Plan	3	2				2			2			2		2		01000																																																																												
H3204	002	1	01	01	2			2			2			2		2		00111															2																																			Discounted Dental Plan	3	2				2			2			2		2		01000																																																																												
H3204	004	2	01	01	2			2			2			2		2		00111															2																																			Discount Dental Plan	3	2				2			2			2		2		01000																																																																												
H3204	005	2	01	01	2			2			2			2		2		00111															2																																			Discounted Dental Plan	3	2				2			2			2		2		01000																																																																												
H3251	002	1	01	01	2			2			2			2		1	0	00111															2																																			Optional Prescription Drugs	3	1	1000	3	5	2			2			2		1	10	00111																																																																												
H3251	017	2	01	01	2			2			2			2		1	0	00111															2																																			Optional Prescription Drugs	3	1	1000	3	5	2			2			2		1	10	00011																																																																												
H3251	018	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H3251	019	1	01	01	2			2			2			2		1	0	00111															2																																																																																																																															
H3255	005	1	05	01	1	1	2	2			2			2		2		00110															2																																																																																																																															
H3255	006	1	05	01	1	1	1	2			2			2		2		00110															1	1	1	1			1	1500	3	4	2			2			2		1	20	10000															Alternative Medicine Providers	1	1	1500	3	4	2			2			2		1	20	01000																																																																												
H3305	001	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3305	004	2	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3307	002	1	01	01	2			2			2			2		2		00001															2																																			Nutrition Health Benefit	1	2				2			2			2		2		01000															Fitness Benefit	1	2				2			2			2		2		01000																																													
H3307	003	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H3307	004	1	02	01	2			2			2			2		2		00001	2				2		1	15	4	1	200	2		00001	2																																			Nutritional Health Benefit	1	2				2			2			2		2		01000															Fitness Benefit	1	2				2			2			2		2		01000																																													
H3307	008	2	01	01	2			2			2			2		2		00001															2																																			Nutrition Health Benefit	1	2				2			2			2		2		01000															Fitness Benefit	1	2				2			2			2		2		01000																																													
H3307	009	2	01	01	2			2			2			2		2		00001															2																																																																																																																															
H3307	010	1	01	01	2			2			2			2		2		00001															2																																			Nutrition Health Benefit	1	2				2			2			2		2		01000															Fitness Benefit	1	2				2			2			2		2		01000																																													
H3312	002	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3312	003	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3312	018	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3312	019	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3330	003	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3330	004	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3330	005	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3330	006	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3330	007	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3330	008	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3330	009	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3330	010	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3330	011	2	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3330	015	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3330	016	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3351	001	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3351	002	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3351	004	2	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3359	001	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	004	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	007	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	008	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	015	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	016	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	017	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3359	018	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H3361	010	1	01	01	2			2			2			2		1	0	00111															1	1	1	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	1	2				2			2			2		1	0	00100																																													
H3361	011	1	01	01	2			2			2			2		1	0	00111															1	1	2	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	012	1	01	01	2			2			2			2		1	0	00111															1	1	2	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	013	1	01	01	2			2			2			2		1	0	00111															1	1	2	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	014	1	01	01	2			2			2			2		1	0	00111															1	1	1	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	015	1	01	01	2			2			2			2		1	0	00111															1	1	1	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	016	1	01	01	2			2			2			2		1	0	00111															1	1	1	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3361	017	1	01	01	2			2			2			2		1	0	00111															1	1	1	2	6	3	2				2			2			2		1	10	01000																																														Health Promotion	2	2				2			2			2		1	0	00100																																													
H3362	003	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	004	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	005	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	006	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	007	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	008	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	009	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	010	1	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3362	013	2	01	01	2			2			2			2		2		00100															2																																			Diabetic Supplies (Insulin)	1	2				2			2			2		1	8	01000															Diabetic DME	1	2				2			2			2		1	15	01000																																													
H3366	001	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H3366	005	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H3366	006	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H3366	007	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H3366	008	1	01	01	1	1	1	2			2			2		2		00001															2																																																																																																																															
H3370	001	1	01	01	2			2			2			2		1	0	00101															2																																																																																																																															
H3370	002	1	01	01	2			2			2			2		1	0	00101															2																																																																																																																															
H3372	001	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3372	002	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3379	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H3379	002	1	01	01	1	1	1	2			2			2		1	0	10000															2																																			Transplant Services	1	2				2			2			2		1	1500	10000																																																																												
H3379	003	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H3379	004	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H3384	013	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	014	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	015	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	016	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	017	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	018	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	019	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	020	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	021	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	022	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	023	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	024	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	025	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	026	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	027	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	028	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	029	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	030	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	031	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3384	032	1	01	01	2			2			2			2		1	10	00111															2																																																																																																																															
H3387	005	1	01	01	1	1	1	2			2			2		2		00100															2																																			Adult Day Care	1	1	500	3	5	2			2			2		1	15	00001															Personal Medical Emergency Response System	1	1	300	3	5	2			2			2		1	20	00001															Home Assessment and Adaptation Services	1	1	200	3	5	2			2			2		2		00001														
H3388	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3449	004	2	01	01	1	1	1	2			2			2		2		00110															1	1	1	1			2				2			2			2		2		00001																																																																																																											
H3449	005	1	01	01	1	1	1	2			2			2		2		00110															1	1	1	1			2				2			2			2		2		00100																																																																																																											
H3455	004	1	01	01	1	1	1	2			2			2		2		00101															2																																			Prescription Drug Discount Card	1	2				2			2			2		2		01000																																																																												
H3455	006	1	01	01	1	1	1	2			2			2		2		00101															2																																			Prescription Drug Discount Card	1	2				2			2			2		2		01000																																																																												
H3456	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H3607	001	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	002	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	003	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	004	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	005	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	006	1	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	007	2	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	008	2	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3607	009	2	01	01	1	1	1	2			2			2		2		00111															2																																			Blood transfusions	1	2				2			2			2		2		00111															Transplants	1	2				2			2			2		2		00111																																													
H3649	001	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3649	004	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3649	005	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3649	009	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3649	010	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3653	004	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3653	005	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3653	006	2	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3653	007	2	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3655	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	002	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	003	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	004	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	005	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	006	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	007	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3655	008	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3657	001	1	01	01	2			2			2			2		2		01000															2																																																																																																																															
H3659	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																																																																												
H3659	002	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																																																																												
H3659	003	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																		2000	3	2	2			1	20	2	2		1	175	00100																																													
H3659	004	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																		2000	3	2	2			1	20	2	2		1	175	00100																																													
H3659	005	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																		2000	3	2	2			1	20	2	2		1	175	00100																																													
H3659	007	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																		2000	3	2	2			1	20	2	2		1	250	00100																																													
H3659	009	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10110																		2000	3	2	2			1	20	2	2		1	175	00100																																													
H3660	003	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3660	006	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3660	007	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3660	008	2	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3663	001	1	01	01	1	1	1	2			2			2		2		00100															2																																																																																																																															
H3664	001	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H3664	003	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H3664	004	1	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H3664	008	2	01	01	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H3668	005	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3668	006	1	01	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3672	001	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3672	003	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3672	005	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3672	009	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3672	010	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3673	004	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H3676	005	1	01	01	2			2			2			2		2		01000															2																																																																																																																															
H3676	008	1	01	01	2			2			2			2		2		01000															2																																																																																																																															
H3749	001	1	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H3755	001	1	01	01	1	1	1	2			2			2		2		00111															2																																			After Hours / Minor Emergency Center Services	1	2				2			2			2		1	15	00100																																																																												
H3756	002	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H3805	001	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H3805	002	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H3805	003	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H3805	005	2	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H3856	005	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3856	007	2	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3856	010	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3864	001	1	05	01	2			2			2			2		1	0	00111															2																																																																																																																															
H3864	002	1	05	01	2			2			2			2		1	0	00111															2																																																																																																																															
H3907	001	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	002	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	003	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	004	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	005	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	006	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	007	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3907	008	1	01	01	2			2			2			2		1	0	00100															2																																																																																																																															
H3931	004	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3931	019	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3931	020	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3931	038	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3931	039	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3949	002	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3952	008	1	02	01	1	1	1	2			2			2		2		01000	2				2		1	20	5	2		2		01000	2																																																																																																																															
H3952	009	1	02	01	1	1	2	2			2			2		2		01000	2				2		1	20	5	2		2		01000	2																																																																																																																															
H3954	003	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3954	004	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3954	005	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3954	006	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3954	007	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3954	008	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H3957	003	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3957	006	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3957	008	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3957	011	1	01	01	1	1	2	2			2			2		2		00101															2																																			Direct Access to Rheumatologists, ENTs & Dermatologists	3	2				2			2			2		1	20	01000																																																																												
H3957	012	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3957	013	1	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3957	015	2	01	01	1	1	2	2			2			2		2		00101															2																																																																																																																															
H3959	001	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3959	002	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3959	003	2	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3959	004	1	01	01	1	1	2	2			2			2		2		00111															2																																																																																																																															
H3959	006	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3959	008	1	01	01	1	1	1	2			2			2		2		00111															2																																																																																																																															
H3962	001	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H3962	002	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H3962	003	1	01	01	1	1	2	2			2			2		1	0	00111															2																																																																																																																															
H3963	001	1	04	01	1	1	2	2			2			2		2		01000															2																																																																																																																															
H3964	001	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H3972	001	1	01	01	1	1	1	2			2			2		2		00100															2																																			Adult Day Care	1	1	1000	3	5	2			2			2		1	10	00001															Personal Medical Emergency Response System	1	1	300	3	5	2			2			2		1	20	00001															Home Assessment and Adaptation Services	1	1	200	3	5	2			2			2		2		00001														
H4003	001	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H4003	002	1	01	01	2			2			2			2		2		00001															2																																																																																																																															
H4102	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H4102	002	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H4102	004	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H4152	004	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H4152	005	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H4152	007	1	01	01	2			2			2			2		1	0	01000															2																																																																																																																															
H4349	002	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H4349	003	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H4454	002	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H4454	006	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H4454	007	1	01	01	1	1	1	2			2			2		2		10101															2																																																																																																																															
H4456	003	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4456	004	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4456	005	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4456	006	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4461	001	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4461	004	1	01	01	2			2			2			2		2		00110															2																																																																																																																															
H4506	001	1	05	01	2			2			2			2		2		01000															2																																																																																																																															
H4506	002	1	05	01	2			2			2			2		2		01000															2																																																																																																																															
H4510	006	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	200	5	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H4510	012	1	01	01	1	1	1	2			2			2		1	0	00111															2																																			High technology drugs	1	1	200	5	5	2			1	25	5	2		1	0	10000															Immediate Care Facility	1	2				2			2			2		1	25	00111																																													
H4510	013	2	01	01	1	1	1	2			2			2		1	0	00111															2																																																																		Immediate Care Facility	1	2				2			2			2		1	25	01000																																													
H4513	001	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H4513	002	1	01	01	2			2			2			2		2		00111															2																																																																																																																															
H4565	001	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H4565	002	1	02	01	2			2			2			2		2		00111															2																																																																																																																															
H4565	003	2	02	01	2			2			2			2		2		00111															2																																																																																																																															
H4590	010	1	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H4590	011	1	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H4590	012	1	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H4590	013	2	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H4590	017	2	01	01	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H4590	018	2	01	01	1	1	2	2			2			2		1	0	00100															2																																																																																																																															
H5005	001	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H5005	002	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H5005	003	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H5005	006	1	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H5005	008	2	01	01	1	1	2	2			2			2		1	0	00110															2																																																																																																																															
H5006	001	1	09	04	2			2			2			2		2		01000															2																																																																																																																															
H5006	002	1	09	04	2			2			2			2		2		01000															2																																																																																																																															
H5006	003	1	09	04	2			2			2			2		2		01000															2																																																																																																																															
H5050	001	1	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	2		2		01000	2																																			Home IV Drug Therapy	2	2				2			2			2		1	0	00110																																																																												
H5050	002	1	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	2		2		01000	2																																			Home IV Drug Therapy	2	2				2			2			2		1	0	00110																																																																												
H5050	004	1	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	2		2		01000	2																																																																																																																															
H5050	005	2	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	2		2		01000	2																																			Home IV Drug Therapy	2	2				2			2			2		1	0	00110																																																																												
H5050	006	2	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	2		2		01000	2																																																																																																																															
H5063	005	1	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	1	100	2		01000	2																																																																																																																															
H5063	006	1	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	1	100	2		01000	2																																																																																																																															
H5063	007	2	02	01	1	1	2	2			2			2		1	0	00110	2				2		1	20	4	1	100	2		01000	2																																																																																																																															
H5066	001	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H5149	001	1	01	01	1	1	1	2			2			2		2		00110															2																																																																																																																															
H5151	001	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H5151	002	1	01	01	1	1	1	2			2			2		2		01000															2																																																																																																																															
H5253	004	1	01	01	1	1	2	2			2			2		2		01000															2																																			Transplant Services	2	2				2			2			2		2		10100																																																																												
H5253	005	2	01	01	1	1	2	2			2			2		2		01000															2																																			Transplant Services	2	2				2			2			2		2		10100																																																																												
H5258	001	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
H5262	001	1	01	01	1	1	2	2			2			2		1	0	01000															2																																																																																																																															
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H9003	001	1	02	01	1	1	2	2			2			2		1	0	00110															2																																			Travel Benefit	2	1	1000	3	1	2			1	20	1	2		2		01000	1	1000	3	4	2		1	20	4	2		2		01000																																																														
H9003	002	1	02	01	1	1	2	2			2			2		1	0	00110															2																																			Travel Benefit	2	1	1000	3	1	2			1	20	1	2		2		01000	1	1000	3	1	2		1	20	4	2		2		01000																																																														
H9003	003	2	02	01	1	1	2	2			2			2		1	0	00110															2																																			Travel Benefit	2	1	1000	3	1	2			1	20	1	2		2		01000	1	1000	3	1	2		1	20	4	2		2		01000																																																														
H9005	002	1	01	01	1	1	2	2			2			2		1	0	00110															1	1	2	1			2				2			2			2		1	15	00110															Accidental Dental Services	2	2				2			2			2		2		10000																																																																												
H9005	004	1	01	01	1	1	2	2			2			2		1	0	00110															1	1	2	1			2				2			2			2		1	10	00110															Accidental Dental Services within the Network	2	2				2			2			2		2		10000																																																																												
H9011	001	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	002	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	003	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	004	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	005	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	006	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9011	007	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9016	002	1	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H9016	004	2	01	01	1	1	1	2			2			2		2		00101															2																																																																																																																															
H9045	003	1	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
H9045	005	2	01	01	1	1	1	2			2			2		2		01000															2																																			Transplant Services	1	2				2			2			2		1	1500	10100																																																																												
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H9047	013	2	01	01	2			2			2			2		2		00101															2																																																																																																																															
H9049	001	1	01	01	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
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H0533	002	1	11	05	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
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H0602	002	1	18	06	2			2			2			2		2		00100															2																																																																																																																															
H0602	003	1	18	06	2			2			2			2		2		00100															2																																																																																																																															
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H0667	001	1	11	05	1	1	1	2			2			2		2		00100															2																																																																																																																															
H0853	001	1	11	05	1	1	1	2			2			2		2		00100															2																																																																																																																															
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H1151	001	1	14	05	1	1	1	2			2			2		1	0	10000	2				2		1	20	4	2		2		01000	2																																			Transplant Services	1	2				2			2			2		1	1500	10000	2				2		1	20	4	2		2		01000																																																														
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H1251	001	1	18	06	2			2			2			2		2		01000															2																																																																																																																															
H1251	002	1	18	06	2			2			2			2		2		01000															2																																																																																																																															
H1349	001	1	18	06	2			2			2			2		1	0	00100															2																																																																																																																															
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H1349	009	1	18	06	2			2			2			2		1	0	00100															2																																																																																																																															
H1472	001	1	18	06	2			2			2			2		2		00110															2																																																																																																																															
H1472	002	1	18	06	2			2			2			2		2		00110															2																																																																																																																															
H1553	001	1	18	06	2			2			2			2		2		00101															2																																																																																																																															
H1553	002	1	18	06	1	1	2	2			2			2		2		00101															2																																																																																																																															
H1555	001	1	18	06	2			2			2			2		2		01000															2																																																																																																																															
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H2456	002	1	12	05	2			2			2			2		2		00100															2																																																																																																																															
H2456	003	1	12	05	2			2			2			2		2		00100															2																																																																																																																															
H2457	002	1	17	05	2			2			2			2		2		00101															2																																																																																																																															
H2458	002	1	17	05	2			2			2			2		2		10000															2																																																																																																																															
H2461	001	1	18	06	1	1	2	2			2			2		2		00110															2																																																																																																																															
H2551	001	1	11	05	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H2961	002	1	10	05	2			2			2			2		2		00111															2																																			Nutritional Services	2	2				2			2			2		2		00001															Home Safety/Personal Emergency Response	1	2				2			2			2		2		00001															Transportation	1	2				2			2			2		2		01000														
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H3356	001	1	18	06	1	1	2	2			2			2		2		00111															2																																																																																																																															
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H3356	003	1	18	06	1	1	2	2			2			2		2		00111															2																																																																																																																															
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H3851	007	1	18	06	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
H3851	008	1	18	06	1	1	1	2			2			2		1	0	01000															2																																																																																																																															
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H4564	002	1	18	06	1	1	1	2			2			2		1	0	00110															2																																																																																																																															
H4564	003	1	18	06	2			2			2			2		2		00110															2																																																																																																																															
H4586	001	1	11	05	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H5077	001	1	11	05	1	1	1	2			2			2		1	0	00100															2																																																																																																																															
H5102	003	1	18	06	1	1	1	2			2			2		2		01000															2																																																																																																																															
H5264	001	1	18	06	1	1	1	2			1	0	1	2		1	0	00100															2																																																																																																																															
H9101	001	1	10	05	2			2			2			2		2		00101															1	1	1	1			2				2			2			2		1	15	00111															Chronic Care Services Benefit	1	1	7800	3	2	2			1	20	2	2		1	12	00001																																														Member to Member Volunteer Services	1	2				2			2			2		2		01000														
H9103	001	1	10	05	1	1	2	2			2			2		1	0	00110															2																																			Travel	2	1	1000	3	1	2			1	20	1	2		2		01000	1	1000	3	4	2		1	20	4	2		2		01000	Expanded Care benefit	2	1	12000	3	2	2			1	20	2	2		2		00110																																													
H9104	006	1	10	05	2			2			2			2		2		00110															2																																			Independent Living Power TM	1	1	625	6	5	1	153	6	2			2		1	10	10000															Optional Dental Services	3	2				2			2			2		1	5	01000															Optional Supplemental Chiropractic and Dental Services	3	2				2			2			2		1	5	01000														
