PBP_A_HNUMBER	PBP_A_PLAN_IDENTIFIER	PBP_A_BEN_COV	PBP_A_PLAN_TYPE	ORGTYPE	PBP_B13A_BENDESC_YN	PBP_B13A_BENDEC	PBP_B13A_BENDESC_AMO	PBP_B13A_MAXENR_YN	PBP_B13A_MAXENR_AMT	PBP_B13A_MAXENR_PER	PBP_B13A_COINS_YN	PBP_B13A_COINS_PCT_MC	PBP_B13A_COINS_COV_MC	PBP_B13A_DED_YN	PBP_B13A_DED_AMT	PBP_B13A_COPAY_YN	PBP_B13A_COPAY_MC_AMT	PBP_B13A_AUTH	PBP_B13A_REFER_YN	PBP_B13B_BENDESC_YN	PBP_B13B_BENDESC_ENHAN	PBP_B13B_BENDESC_AMO	PBP_B13B_BENDESC_LIM	PBP_B13B_BENDESC_NUMV	PBP_B13B_BENDESC_PER	PBP_B13B_MAXPLAN_YN	PBP_B13B_MAXPLAN_AMT	PBP_B13B_MAXPLAN_PER	PBP_B13B_MAXPLAN_COV	PBP_B13B_MAXENR_YN	PBP_B13B_MAXENR_AMT	PBP_B13B_MAXENR_PER	PBP_B13B_COINS_YN	PBP_B13B_COINS_PCT	PBP_B13B_COINS_COV	PBP_B13B_DED_YN	PBP_B13B_DED_AMT	PBP_B13B_COPAY_YN	PBP_B13B_COPAY_AMT	PBP_B13B_AUTH	PBP_B13B_REFER_YN	PBP_B13C_BENDESC_SERVICE	PBP_B13C_BENDESC_AMO	PBP_B13C_MAXPLAN_YN	PBP_B13C_MAXPLAN_AMT	PBP_B13C_MAXPLAN_PER	PBP_B13C_MAXPLAN_COV	PBP_B13C_MAXENR_YN	PBP_B13C_MAXENR_AMT	PBP_B13C_MAXENR_PER	PBP_B13C_COINS_YN	PBP_B13C_COINS_PCT	PBP_B13C_COINS_COV	PBP_B13C_DED_YN	PBP_B13C_DED_AMT	PBP_B13C_COPAY_YN	PBP_B13C_COPAY_AMT	PBP_B13C_AUTH	PBP_B13C_REFER_YN	PBP_B13D_BENDESC_SERVICE	PBP_B13D_BENDESC_AMO	PBP_B13D_MAXPLAN_YN	PBP_B13D_MAXPLAN_AMT	PBP_B13D_MAXPLAN_PER	PBP_B13D_MAXPLAN_COV	PBP_B13D_MAXENR_YN	PBP_B13D_MAXENR_AMT	PBP_B13D_MAXENR_PER	PBP_B13D_COINS_YN	PBP_B13D_COINS_PCT	PBP_B13D_COINS_COV	PBP_B13D_DED_YN	PBP_B13D_DED_AMT	PBP_B13D_COPAY_YN	PBP_B13D_COPAY_AMT	PBP_B13D_AUTH	PBP_B13D_REFER_YN	PBP_B13E_BENDESC_SERVICE	PBP_B13E_BENDESC_AMO	PBP_B13E_MAXPLAN_YN	PBP_B13E_MAXPLAN_AMT	PBP_B13E_MAXPLAN_PER	PBP_B13E_MAXPLAN_COV	PBP_B13E_MAXENR_YN	PBP_B13E_MAXENR_AMT	PBP_B13E_MAXENR_PER	PBP_B13E_COINS_YN	PBP_B13E_COINS_PCT	PBP_B13E_COINS_COV	PBP_B13E_DED_YN	PBP_B13E_DED_AMT	PBP_B13E_COPAY_YN	PBP_B13E_COPAY_AMT	PBP_B13E_AUTH	PBP_B13E_REFER_YN					
H0150	001	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H0151	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H0151	002	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H0154	001	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H0302	001	1	01	01	1	1	2	2			2			2		2		00110	2	2																						Personal Travel Program	2	1	1000.00	3	4	2			2			2		1	15.00	00110	1																																									
H0302	002	1	01	01	1	1	2	2			2			2		2		00110	1	2																						Personal Travel Program	2	1	1000.00	3	4	2			2			2		1	15.00	10110	1	Personal Care Services	1	2				2			2			2		2		00111	1																							
H0303	013	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0303	015	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0303	022	2	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0307	004	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H0350	001	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H0351	007	1	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H0351	008	1	01	01	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H0351	014	1	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H0351	016	2	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H0351	017	2	01	01	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H0351	021	2	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H0351	023	1	01	01	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H0354	001	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H0354	009	2	01	01	2			2			2			2		2		00111	2	2																																																																																
H0504	015	1	01	01	1	1	1	2			2			2		2		00111	1	2																						Diaphragms and their fitting	1	2				2			2			2		1	25.00	00111	2	Care Package	1	2				2			2			2		2		00111	2	Silver Sneakers	1	2				2			2			2		2		01000	2					
H0504	016	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Diaphragms and their fitting	2	2				2			2			2		1	25.00	00111	2	Care Package	2	2				2			2			2		2		00111	2	Silver Sneakers	2	2				2			2			2		2		01000	2					
H0504	017	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Diaphragms and their fitting	2	2				2			2			2		1	25.00	00111	2	Care Package	2	2				2			2			2		2		00111	2	Silver Sneakers	2	2				2			2			2		2		01000	2					
H0504	018	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Diaphragms and their fitting	2	2				2			2			2		1	25.00	00111	2	Care Package	2	2				2			2			2		2		00111	2	Silver Sneakers	2	2				2			2			2		2		01000	2					
H0504	019	2	01	01	1	1	1	2			2			2		2		00111	1	2																						Diaphragms and their fitting	1	2				2			2			2		1	25.00	00111	2	Care Package	1	2				2			2			2		2		00111	2	Silver Sneakers	1	2				2			2			2		2		01000	2					
H0504	020	2	01	01	1	1	2	2			2			2		2		00111	1	2																						Diaphragms and their fitting	2	2				2			2			2		1	25.00	00111	2	Care Package	2	2				2			2			2		2		00111	2	Silver Sneakers	2	2				2			2			2		2		01000	2					
H0523	002	1	01	01	1	1	1	2			2			2		2		00111	1	2																						Transitional Care	3	2				2			2			2		2		00100	1																																									
H0523	022	1	01	01	1	1	1	2			2			2		2		00111	1	2																						Transitional Care	3	2				2			2			2		2		00100	1																																									
H0524	001	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	002	2	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	003	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	006	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	007	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	008	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	009	1	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0524	010	2	01	01	1	1	1	2			2			2		2		00110	2	2																						Abortion	1	2				2			2			2		1	10.00	00110	2																																									
H0532	001	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H0532	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H0538	001	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H0538	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H0543	001	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0543	004	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0543	007	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	013	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	019	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	022	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	026	2	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	028	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	029	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	030	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	032	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H0543	035	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	036	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	037	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	038	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	040	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	046	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	047	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	048	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	049	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	050	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0543	060	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H0545	001	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0545	002	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0545	003	2	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0545	004	2	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0545	005	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0545	006	2	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H0562	002	1	01	01	1	1	1	2			2			2		2		00101	1	2																																																																																
H0562	009	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	010	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	011	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	012	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	017	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	019	2	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	029	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	031	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	032	1	01	01	1	1	1	2			2			2		2		00101	1	2																																																																																
H0562	033	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	036	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	037	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0562	039	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H0564	003	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	004	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	005	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	006	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	007	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	008	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	009	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	010	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0564	023	2	02	01	1	1	2	2			2			2		1	0.00	10100	1	2																																																																																
H0564	024	1	02	01	1	1	2	2			2			2		1	0.00	10100	1	2																																																																																
H0564	026	1	02	01	1	1	1	2			2			2		1	0.00	10100	1	2																																																																																
H0571	001	1	01	01	1	1	1	2			2			2		1	0.00	01000	1	1	1	1	1			2				2			2			2		1	7.00	01000	1																																																											
H0571	002	2	01	01	1	1	1	2			2			2		1	0.00	01000	1	1	1	1	1			2				2			2			2		1	7.00	01000	1																																																											
H0609	002	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0609	003	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0609	006	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0609	007	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0609	008	2	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0630	004	1	01	01	1	1	1	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	1	2				2			2			2		1	15.00	00110	1																																									
H0630	005	1	02	01	1	1	1	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	1	2				2			2			2		1	15.00	00110	1																																									
H0630	006	1	02	01	1	1	1	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	1	2				2			2			2		1	15.00	00110	1																																									
H0630	007	2	01	01	1	1	1	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	1	2				2			2			2		1	15.00	00110	1																																									
H0630	008	2	02	01	1	1	1	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	1	2				2			2			2		1	15.00	00110	1																																									
H0630	009	2	02	01	1	1	2	2			2			2		2		00110	1	2																						Family Planning and Infertility Treatment	2	2				2			2			2		1	15.00	00110	1																																									
H0752	002	1	01	01	2			2			2			2		2		00001	2	2																																																																																
H0755	001	1	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H0755	007	2	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H0755	010	1	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H0755	011	1	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H0802	001	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H0954	002	1	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H0954	003	1	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H0954	004	1	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H0954	008	2	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H0954	014	1	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H0954	015	1	01	01	2			2			2			2		2		01000	1	2																						Clinical Trials	2	2				2			2			2		1	15.00	00001	1																																									
H1013	011	1	01	01	1	1	1	2			2			2		2		00111	1	2																						over-the-counter items	1	1	25.00	5	3	2			2			2		2		01000	2																																									
H1013	012	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1013	013	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H1013	014	2	01	01	1	1	2	2			2			2		2		00111	1	2																						over-the-counter items	1	1	25.00	5	3	2			2			2		2		01000	2																																									
H1013	015	2	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H1013	016	2	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H1016	001	1	01	01	2			2			2			2		1	0.00	00111	1	2																																																																																
H1016	002	1	01	01	2			2			2			2		1	0.00	00111	1	2																																																																																
H1016	007	1	01	01	2			2			2			2		1	0.00	00111	1	2																																																																																
H1016	017	2	01	01	2			2			2			2		1	0.00	00111	1	2																																																																																
H1019	001	1	01	01	1	1	1	2			2			2		2		00111	1	1	1	1	1			2				2			2			2		2		01000	2	Emergency Response System	1	2				2			2			2		1	25.00	10000	2																																									
H1019	002	1	01	01	1	1	1	2			2			2		2		00111	1	1	1	1	1			2				2			2			2		2		01000	2	Emergency Response System	1	2				2			2			2		1	25.00	10000	2																																									
H1026	001	1	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	002	1	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	004	1	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	008	2	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	009	2	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	011	2	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	012	1	01	01	1	1	2	2			2			2		2		01000	1	2																						Allergy Injections	2	2				2			2			2		1	5.00	01000	2																																									
H1026	017	1	01	01	1	1	2	2			2			2		2		01000	1	2																																																																																
H1027	003	1	01	01	1	1	1	2			2			2		2		00111	1	2																						vitamins	1	2				2			2			2		2		01000	2																																									
H1032	002	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	004	1	01	01	2			2			2			2		2		00110	1	2																						Non-Par Inpatient Hospital Care	1	2				2			2			2		1	250.00	00111	1	Injectibles	1	2				2			2			2		1	75.00	00100	1																							
H1032	006	1	01	01	2			2			2			2		2		00110	1	2																						Non-Par Inpatient Hospital Care	1	2				2			2			2		1	250.00	00111	1	Injectibles	1	2				2			2			2		1	75.00	00100	1																							
H1032	008	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	009	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	010	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	012	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	014	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	019	1	01	01	2			2			2			2		2		00110	1	2																						Inpatient Non-Par Hospital Care	1	2				1	1000.00	6	2			2		1	200.00	00111	1	Injectibles	1	2				2			2			2		1	75.00	00100	1																							
H1032	020	1	01	01	2			2			2			2		2		00110	1	2																						Injectibles	1	2				2			2			2		1	75.00	00100	1																																									
H1032	021	1	01	01	2			2			2			2		2		00110	1	2																						Inpatient Non-Par Hospital Care	1	2				1	1000.00	6	2			2		1	200.00	00111	1	Injectibles	1	2				2			2			2		1	75.00	00100	1																							
H1032	025	1	01	01	2			2			2			2		2		00110	1	2																																																																																
H1034	001	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H1034	003	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H1035	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H1035	004	2	01	01	2			2			2			2		2		00111	1	2																																																																																
H1036	011	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	016	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	025	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	034	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	035	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	037	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	040	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	044	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	047	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	048	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	050	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1036	052	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1040	001	1	04	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H1040	002	1	04	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H1045	001	1	05	01	2			2			2			2		2		01000	2	2																																								Over-the-counter program	1	1	15.00	6	3	2			2			2		2		01000	2																							
H1076	001	1	01	01	1	1	1	2			2			2		2		00111	1	2																						vitamins	1	2				2			2			2		2		01000	2																																									
H1076	002	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H1076	003	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1076	006	2	01	01	1	1	1	2			2			2		2		00111	1	2																						vitamins	1	2				2			2			2		2		01000	2																																									
H1076	008	2	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1078	001	1	01	01	2			2			2			2		2		00111	1	2																						Vitamins	1	1	15.00	5	3	2			2			2		2		01000	2																																									
H1078	002	2	01	01	2			2			2			2		2		00111	1	2																						Vitamins	1	1	15.00	5	3	2			2			2		2		01000	2																																									
H1078	003	1	01	01	2			2			2			2		2		00111	1	2																						Vitamins	2	1	15.00	5	3	2			2			2		2		01000	2																																									
H1078	004	2	01	01	2			2			2			2		2		00111	1	2																						Vitamins	2	1	15.00	5	3	2			2			2		2		01000	2																																									
H1078	005	1	01	01	2			2			2			2		2		00111	1	2																						Vitamins	2	1	15.00	5	3	2			2			2		2		01000	2																																									
H1080	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H1080	011	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H1080	013	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H1099	001	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H1106	001	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1168	004	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H1168	005	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H1170	002	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Clinical Trial	2	2				2			2			2		1	15.00	00101	1																																									
H1170	005	2	01	01	1	1	2	2			2			2		2		00111	1	2																						Clinical Trial	2	2				2			2			2		1	15.00	00101	1																																									
H1230	001	1	01	01	1	1	1	2			2			2		2		00110	2	2																																																																																
H1230	002	2	01	01	1	1	1	2			2			2		2		00110	2	2																																																																																
H1350	001	1	01	01	1	1	2	2			2			2		2		01000	2	2																						Travelers Benefit	2	1	3000.00	3	4	2			2			2		1	15.00	01000	2																																									
H1406	006	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1406	007	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1406	013	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1406	014	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1406	015	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1406	016	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H1463	001	1	01	01	1	1	2	2			2			2		2		00100	1	2																																																																																
H1468	004	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H1506	001	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H1506	002	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H1849	003	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H1849	004	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H1951	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H1951	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H1951	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H1961	001	1	02	01	1	1	1	2			2			2		1	0.00	00101	1	2																						Organ Transplants	1	2				2			2			2		1	0.00	00101	1																																									
H2108	001	1	01	01	2			2			1	20	4	2		2		00001	1	2																						NURSE PRACTICIONER OFFICE VISITS	1	2				2			2			2		2		00001	2	MASSSAGE THERAPY	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	1	HAIR SALON SERVICE	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	2					
H2108	002	1	01	01	2			2			1	20	4	2		2		00001	1	2																						NURSE PRACTICIONER OFFICE VISITS	1	2				2			2			2		2		00001	2	MASSSAGE THERAPY	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	1	HAIR SALON SERVICE	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	2					
H2204	007	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H2206	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H2206	013	2	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H2256	001	1	01	01	1	1	2	2			2			2		2		00101	2	2																																																																																
H2256	002	1	01	01	1	1	2	2			2			2		2		00101	2	2																																																																																
H2256	005	2	01	01	1	1	2	2			2			2		2		00101	2	2																																																																																
H2256	006	1	01	01	1	1	2	2			2			2		2		00101	2	2																																																																																
H2261	005	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2261	006	2	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2261	007	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2261	008	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2261	009	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2261	010	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H2312	004	1	01	01	1	1	1	2			2			2		2		00101	1	2																																																																																
H2353	001	1	01	01	1	1	1	2			2			2		2		00101	1	2																																																																																
H2354	001	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H2354	007	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H2354	008	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H2354	009	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H2403	002	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H2403	003	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H2403	004	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H2403	005	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H2406	001	1	04	01	2			2			2			2		2		10000	1	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H2406	003	1	04	01	2			2			2			2		2		10000	1	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H2459	001	1	01	01	1	1	1	2			2			2		2		00100	2	2																																																																																
H2459	002	1	02	01	1	1	1	2			2			2		2		00100	2	2																																																																																
H2502	001	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H2649	004	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H2649	006	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H2654	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H2654	005	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H2654	008	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H2663	001	1	01	01	1	1	2	2			2			2		2		00100	1	2																																																																																
H2663	002	1	01	01	1	1	2	2			2			2		2		00100	1	2																																																																																
H2663	003	2	01	01	1	1	2	2			2			2		2		00100	1	2																																																																																
H2666	004	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H2667	001	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	002	2	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	003	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	004	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	005	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	006	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2667	010	1	01	01	1	1	1	2			2			2		1	0.00	00110	1	2																																																																																
H2672	001	1	01	01	1	1	1	2			2			2		2		00100	1	2																																																																																
H2802	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H2931	002	1	02	01	2			2			2			2		2		00111	1	2																																																																																
H2931	004	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H2931	006	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H2931	008	2	01	01	2			2			2			2		2		00111	1	2																																																																																
H2949	002	1	01	01	1	1	1	2			2			2		2		00110	1	2																																																																																
H2949	005	2	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H2960	004	1	02	01	2			2			1	20	2	2		2		00111	1	2																																																																																
H2960	005	1	02	01	2			2			1	20	2	2		2		00111	2	2																																																																																
H3107	001	1	01	01	2			2			2			2		2		00001	2	2																																																																																
H3152	022	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3152	029	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3154	001	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3154	003	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3156	021	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3164	001	1	01	01	1	1	1	2			2			2		1	0.00	01000	1	2																						Adult Day Care	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Personal Medical Emergency Response System	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Home Assessment and Adaptation Services	1	1	500.00	3	5	2			2			2		1	0.00	00001	2					
H3164	002	1	01	01	1	1	1	2			2			2		1	0.00	01000	1	2																						Adult Day Care	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Personal Medical Emergency Response System	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Home Assessment and Adaptation Services	1	1	500.00	3	5	2			2			2		1	0.00	00001	2					
H3204	001	1	02	01	2			2			2			2		2		00111	1	2																						Discount Dental Plan	3	2				2			2			2		2		01000	2																																									
H3204	002	1	02	01	2			2			2			2		2		00111	1	2																						Discount Dental Plan	3	2				2			2			2		2		01000	2																																									
H3204	004	2	02	01	2			2			2			2		2		00111	1	2																						Discount Dental Plan	3	2				2			2			2		2		01000	2																																									
H3204	005	2	02	01	2			2			2			2		2		00111	1	2																						Discount Dental Plan	3	2				2			2			2		2		01000	2																																									
H3251	002	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3251	017	2	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3251	018	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3255	005	1	06	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3255	006	1	06	01	1	1	1	2			2			2		2		01000	2	1	1	1	1			1	1500.00	3	4	2			2			2		1	20.00	00111	1	Alternative Medicine Providers	1	1	1500.00	3	4	2			2			2		1	20.00	01000	2																																									
H3305	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Travel Benefit	1	1	3000.00	3	4	2			1	30	2	1	100.00	2		00001	2																																									
H3305	004	2	01	01	1	1	1	2			2			2		2		01000	2	2																						Travel Benefit	1	1	3000.00	3	4	2			1	30	2	1	100.00	2		00001	2																																									
H3307	002	1	01	01	2			2			2			2		2		00001	2	2																						Nutrition Health Benefit	1	2				2			2			2		2		01000	2	Fitness Benefit	1	2				2			2			2		2		01000	2																							
H3307	004	1	02	01	2			2			2			2		2		00001	2	2																						Nutrition Health Benefit	1	2				2			2			2		2		01000	2	Fitness Benefit	1	2				2			2			2		2		01000	2																							
H3307	008	2	01	01	2			2			2			2		2		00001	2	2																						Nutrition Health Benefit	1	2				2			2			2		2		01000	2	Fitness Benefit	1	2				2			2			2		2		01000	2																							
H3307	010	1	01	01	2			2			2			2		2		00001	2	2																						Nutrition Health Benefit	1	2				2			2			2		2		01000	2	Fitness Benefit	1	2				2			2			2		2		01000	2																							
H3312	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3312	018	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3330	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3330	004	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3330	005	1	01	01	1	1	2	2			2			2		2		01000	1	2																																																																																
H3330	006	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3330	007	1	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H3330	008	1	01	01	1	1	2	2			2			2		2		00001	1	2																																																																																
H3330	009	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3330	010	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3330	011	2	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3351	001	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3351	002	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3351	004	2	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3359	001	1	01	01	2			2			2			2		1	0.00	01000	1	2																																																																																
H3359	007	1	01	01	2			2			2			2		1	0.00	01000	1	2																																																																																
H3359	008	1	01	01	2			2			2			2		1	0.00	01000	1	2																																																																																
H3359	019	1	01	01	2			2			2			2		1	0.00	01000	1	2																						Prescription Drugs Reimbursement	1	1	240.00	3	5	2			2			2		2		01000	2																																									
H3359	020	1	01	01	2			2			2			2		1	0.00	01000	1	2																						Coordinated Care with a Physician Extender	1	2				2			2			2		2		01000	1	Family Consultations	1	2				2			2			2		1	0.00	01000	1																							
H3359	021	1	01	01	2			2			1	20	2	2		2		01000	1	2																						Initial Home Assessment	1	2				2			2			2		1	0.00	01000	2	Home Health Safety Improvement	1	1	500.00	6	5	2			2			2		1	0.00	00001	2	Non-prescription drugs	1	1	30.00	5	2	2			2			2		1	0.00	01000	2					
H3361	010	1	01	01	2			2			2			2		2		00111	1	1	1	1	2	6	3	2				2			2			2		1	10.00	01000	1	Injectibles	2	2				2			1	20	2	2		2		00100	1																																									
H3361	012	1	01	01	2			2			2			2		2		00111	1	1	1	1	2	6	3	2				2			2			2		1	10.00	01000	1	Injectibles	2	2				2			1	20	2	2		2		00100	1																																									
H3361	014	1	01	01	2			2			2			2		2		00111	1	1	1	1	2	6	3	2				2			2			2		1	10.00	01000	1	Injectibles	2	2				2			1	20	2	2		2		00111	1																																									
H3361	016	1	01	01	2			2			2			2		2		00111	1	1	1	1	2	6	3	2				2			2			2		1	10.00	01000	1	Inpatient Non-Par Hospital Care	1	2				1	2000.00	3	2			2		1	200.00	00111	1	Injectibles	2	2				2			1	20	2	2		2		00111	1																							
H3362	003	1	01	01	2			2			2			2		2		00110	2	2																						Diabetic DME	1	2				2			2			2		1	20.00	00001	2																																									
H3362	004	1	01	01	2			2			2			2		2		00110	2	2																						Diabetic DME	1	2				2			2			2		1	20.00	00001	2																																									
H3362	013	2	01	01	2			2			2			2		2		00110	2	2																						Diabetic DME	1	2				2			2			2		1	20.00	00001	2																																									
H3366	001	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3366	005	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3366	007	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3366	008	1	01	01	1	1	1	2			2			2		2		00001	1	2																																																																																
H3370	001	1	01	01	2			2			2			2		1	0.00	00101	1	2																																																																																
H3370	002	1	01	01	2			2			2			2		1	0.00	00101	1	2																																																																																
H3370	003	1	01	01	2			2			2			2		1	0.00	00101	1	2																																																																																
H3370	004	1	01	01	2			2			2			2		1	0.00	00101	1	2																																																																																
H3379	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3379	002	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3379	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3379	005	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	500.00	10000	2																																									
H3384	013	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	014	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	015	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	016	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	019	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	020	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	022	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3384	024	1	01	01	2			2			2			2		1	10.00	00111	2	2																																																																																
H3387	005	1	01	01	1	1	1	2			2			2		1	0.00	01000	1	2																						Adult Day Care	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Personal Medical Emergency Response System	1	1	500.00	3	5	2			2			2		1	20.00	00001	2	Home Assessment and Adaptation Services	1	1	500.00	3	5	2			2			2		1	0.00	00001	2					
H3388	001	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3449	004	2	01	01	1	1	1	2			2			2		2		00001	2	2																																																																																
H3449	005	1	01	01	1	1	1	2			2			2		2		00001	2	2																																																																																
H3449	009	1	01	01	1	1	1	2			2			2		2		00001	2	2																																																																																
H3455	004	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H3455	006	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H3456	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H3456	002	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3607	001	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Blood transfusions	2	2				2			2			2		2		00111	1	Transplants	2	2				2			2			2		2		00111	1	Clinical Trials	2	2				2			2			2		1	15.00	00111	1					
H3607	002	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Blood transfusions	2	2				2			2			2		2		00111	1	Transplants	2	2				2			2			2		2		00111	1	Clinical Trials	2	2				2			2			2		1	15.00	00111	1					
H3607	003	2	01	01	1	1	2	2			2			2		2		00111	1	2																						Blood transfusions	2	2				2			2			2		2		00111	1	Transplants	2	2				2			2			2		2		00111	1	Clinical Trials	2	2				2			2			2		1	15.00	00111	1					
H3653	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3653	005	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3653	006	2	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3653	007	2	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3655	001	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3655	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3655	009	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3657	001	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3659	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	002	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	007	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	017	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3659	018	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	2																																									
H3660	003	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3660	006	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3660	007	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3664	001	1	01	01	1	1	1	2			2			2		2		00111	2	2																																																																																
H3664	003	1	01	01	1	1	1	2			2			2		2		00111	2	2																																																																																
H3664	004	1	01	01	1	1	1	2			2			2		2		00111	2	2																																																																																
H3664	008	2	01	01	1	1	1	2			2			2		2		00111	2	2																																																																																
H3668	005	1	01	01	1	1	2	2			2			2		2		01000	2	2																						Lovenox	2	2				2			2			2		2		01000	2																																									
H3672	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3672	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3672	009	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3672	010	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H3673	004	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H3749	001	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H3755	001	1	01	01	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H3805	001	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H3805	005	2	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H3856	005	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3856	007	2	01	01	2			2			2			2		2		01000	2	2																																																																																
H3856	010	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3856	011	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3864	001	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3864	002	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H3864	003	1	02	01	2			2			2			2		2		01000	2	2																																																																																
H3864	004	1	02	01	2			2			2			2		2		01000	2	2																																																																																
H3907	001	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	002	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	003	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	004	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	005	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	006	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	007	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	008	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	009	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3907	010	1	01	01	2			2			2			2		2		00100	2	2																																																																																
H3912	001	1	04	01	2			2			2			2		2		10000	1	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H3931	004	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3931	019	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3931	039	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3949	002	1	01	01	2			2			1	20	4	2		2		00001	1	2																						NURSE PRACTICIONER OFFICE VISITS	1	2				2			2			2		2		00001	2	MASSAGE THERAPY	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	1	HAIR SALON SERVICE	1	1	1.00	6	2	1	0.00	6	2			2		2		00001	2					
H3952	008	1	02	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3952	009	1	02	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3952	018	1	02	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3952	019	1	02	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H3954	003	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3954	004	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3954	005	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3954	006	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3954	007	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3954	008	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3957	003	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	3	1	1000.00	3	4	2			2			2		1	20.00	01000	2																																									
H3957	006	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	3	1	1000.00	3	4	2			2			2		1	20.00	01000	2																																									
H3957	008	1	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H3957	015	2	01	01	1	1	2	2			2			2		2		00101	1	2																																																																																
H3957	016	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	3	1	1000.00	3	4	2			2			2		1	20.00	01000	2																																									
H3957	017	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	2	1	1000.00	3	4	2			2			2		1	30.00	01000	2																																									
H3957	018	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	2	1	1000.00	3	4	2			2			2		1	30.00	01000	2																																									
H3957	019	1	01	01	1	1	2	2			2			2		2		00101	1	2																						Limited Out-of-Service Area Benefit	2	1	1000.00	3	4	2			2			2		1	30.00	01000	2																																									
H3959	001	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3959	002	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3959	003	2	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3959	004	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3959	006	1	01	01	1	1	2	2			2			2		2		00111	1	2																																																																																
H3959	008	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H3962	001	1	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H3962	002	1	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H3962	003	1	01	01	1	1	2	2			2			2		1	0.00	00111	1	2																																																																																
H3964	001	1	01	01	2			2			2			2		2		00110	1	2																						Dentures	1	1	200.00	3	3	2			2			2		2		00110	1																																									
H3972	001	1	01	01	1	1	1	2			2			2		1	0.00	01000	1	2																						Adult Day Care	1	1	1000.00	3	5	2			2			2		1	10.00	00001	2	Personal Medical Emergency Response System	1	1	300.00	3	5	2			2			2		1	20.00	00001	2	Home Assessment and Adaptation Services	1	1	200.00	3	5	2			2			2		1	0.00	00001	2					
H4003	001	1	01	01	2			2			2			2		2		00001	1	2																						Travel Benefit	3	1	2000.00	3	4	2			2			2		2		01000	2																																									
H4003	002	1	01	01	2			2			2			2		2		00001	1	2																						Travel Benefit	3	1	2000.00	3	4	2			2			2		2		01000	2																																									
H4003	003	1	01	01	2			2			2			2		2		00001	1	2																						Travel Benefit	3	1	2000.00	3	4	2			2			2		2		01000	2																																									
H4102	001	1	01	01	1	1	1	2			2			2		2		01000	1	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H4102	002	1	01	01	1	1	1	2			2			2		2		01000	1	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H4152	004	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H4152	005	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H4152	007	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H4349	002	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H4349	003	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H4349	004	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H4349	005	1	01	01	2			2			2			2		2		00111	2	2																																																																																
H4454	002	1	01	01	1	1	1	2			2			2		2		00100	1	2																																																																																
H4454	006	1	01	01	1	1	1	2			2			2		2		00100	1	2																																																																																
H4456	003	1	01	01	2			2			2			2		1	0.00	00110	2	2																																																																																
H4456	004	1	01	01	2			2			2			2		1	0.00	00110	2	2																																																																																
H4456	005	1	01	01	2			2			2			2		1	0.00	00110	2	2																																																																																
H4456	006	1	01	01	2			2			2			2		1	0.00	00110	2	2																																																																																
H4461	001	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H4461	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H4506	001	1	05	01	2			2			2			2		2		01000	2	2																																																																																
H4506	002	1	05	01	2			2			2			2		2		01000	2	2																																																																																
H4506	003	1	05	01	2			2			2			2		2		00001	1	2																																																																																
H4506	004	1	05	01	2			2			2			2		2		00001	1	2																																																																																
H4510	006	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H4510	012	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H4510	014	1	01	01	1	1	1	2			2			2		2		00111	1	2																																																																																
H4513	001	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H4513	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H4513	003	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H4514	001	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H4590	010	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H4590	011	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H4590	012	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H4590	013	2	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H5005	001	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H5005	003	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H5005	006	1	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H5005	008	2	01	01	1	1	2	2			2			2		2		00110	1	2																																																																																
H5006	001	1	09	04	2			2			2			2		2		01000	2	2																																																																																
H5006	003	1	09	04	2			2			2			2		2		01000	2	2																																																																																
H5050	001	1	02	01	2			2			2			2		2		00110	1	2																						Home IV Drug Therapy	2	2				2			2			2		1	0.00	00110	1																																									
H5050	002	1	02	01	2			2			2			2		2		00110	1	2																						Home IV Drug Therapy	2	2				2			2			2		1	0.00	00110	1																																									
H5050	004	1	02	01	2			2			2			2		2		00110	1	2																																																																																
H5050	005	2	02	01	2			2			2			2		2		00110	1	2																						Home IV Drug Therapy	2	2				2			2			2		1	0.00	00110	1																																									
H5050	006	2	02	01	2			2			2			2		2		00110	1	2																																																																																
H5149	001	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H5151	002	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H5211	001	1	02	01	1	1	1	2			2			2		2		01000	2	2																																																																																
H5262	001	1	01	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H9001	001	1	01	01	2			2			2			2		2		00111	1	2																						Weight Watchers	1	2				2			2			2		2		01000	2	Project at Home	1	2				2			2			2		2		00101	1																							
H9001	004	1	01	01	2			2			2			2		2		00111	1	2																						Weight Watchers	1	2				2			2			2		2		01000	2																																									
H9003	001	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Travel Benefit	2	1	1000.00	3	1	2			1	20	1	2		2		01000	2	Visiting Member Benefit	2	2				2			2			2		2		01000	2	Clinical Trials	2	2				2			1	20	4	1	816.00	1	10.00	00111	1					
H9003	002	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Travel Benefit	2	1	1000.00	3	1	2			1	20	1	2		2		01000	2	Visiting Member Benefit	2	2				2			2			2		2		01000	2	Clinical Trials	2	2				2			2			2		2		01000	1					
H9003	003	2	01	01	1	1	2	2			2			2		2		00111	1	2																						Travel Benefit	2	1	1000.00	3	1	2			1	20	1	2		2		01000	2	Visiting Member Benefit	2	2				2			2			2		2		01000	2	Clinical Trials	2	2				2			2			2		2		01000	1					
H9003	005	1	01	01	1	1	2	2			2			2		2		00111	1	2																						Travel Benefit	2	1	1000.00	3	1	2			1	20	1	2		2		01000	2	Visiting Member Benefit	2	2				2			2			2		2		01000	2	Clinical Trials	2	2				2			2			2		2		01000	1					
H9005	004	1	01	01	1	1	2	2			2			2		2		00110	1	1	1	2	1			2				2			2			2		1	10.00	00100	1																																																											
H9011	003	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H9011	004	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H9011	009	1	01	01	1	1	1	2			2			2		2		01000	2	2																						Transplant Services	1	2				2			2			2		1	1500.00	10000	1																																									
H9016	002	1	01	01	2			2			2			2		2		00100	1	2																																																																																
H9016	004	2	01	01	2			2			2			2		2		00100	1	2																																																																																
H9047	001	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H9047	013	2	01	01	2			2			2			2		2		00101	1	2																																																																																
H9047	019	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H9047	020	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H9047	021	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H9047	022	1	01	01	2			2			2			2		2		00101	1	2																																																																																
H9049	001	1	01	01	2			2			2			2		2		01000	2	2																																																																																
H0357	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H0602	001	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H0602	002	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H0602	003	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H0602	004	1	18	06	2			2			2			2		2		00100	1	2																						MRI	2	2				2			2			2		1	100.00	00101	1																																									
H0619	001	1	01	01	1	1	2	2			2			2		2		00110	2	2																																																																																
H0662	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H0662	002	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H1083	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H1151	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H1251	001	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H1251	002	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H1349	001	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H1349	006	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H1349	008	2	18	06	2			2			2			2		2		00100	1	2																																																																																
H1349	009	1	18	06	2			2			2			2		2		00100	1	2																																																																																
H1407	001	1	09	04	2			2			2			2		2		01000	2	2																																																																																
H1472	001	1	18	06	2			2			2			2		1	0.00	00110	2	2																																																																																
H1472	002	1	18	06	2			2			2			2		2		00110	2	2																																																																																
H1558	003	1	18	06	2			2			2			2		2		00111	1	2																																																																																
H1558	004	1	18	06	1	1	1	2			2			2		2		00111	1	2																																																																																
H1558	005	2	18	06	2			2			2			2		2		00111	1	2																																																																																
H1803	001	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H2155	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H2259	001	1	14	05	2			2			2			2		2		10000	1	2																																																																																
H2317	001	1	01	01	1	1	1	2			2			2		2		00101	1	2																																																																																
H2407	001	1	16	05	2			2			2			2		2		00100	2	2																																																																																
H2450	001	1	18	06	1	1	2	2			2			2		2		01000	2	2																																																																																
H2450	002	1	18	06	1	1	2	2			2			2		2		01000	2	2																																																																																
H2456	002	1	16	05	2			2			2			2		2		00100	2	2																																																																																
H2457	002	1	16	05	1	1	2	2			2			2		2		01000	2	1	1	2	1			2				2			2			2		2		01000	2																																																											
H2458	002	1	16	05	1	1	2	2			2			2		2		00100	1	2																																																																																
H2961	002	1	10	05	2			2			2			2		2		00111	1	2																																																																																
H2961	010	1	10	05	2			2			2			2		2		00111	1	2																																																																																
H3610	001	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3610	002	1	01	01	2			2			2			2		2		00111	1	2																																																																																
H3851	005	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H3851	006	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H3851	007	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H3851	008	1	18	06	2			2			2			2		2		01000	2	2																																																																																
H3909	001	1	04	01	1	1	2	2			2			2		2		01000	2	2																																																																																
H4564	001	1	18	06	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H4564	002	1	18	06	1	1	1	2			2			2		1	0.00	00111	1	2																																																																																
H4564	003	1	18	06	2			2			2			2		2		00111	1	2																																																																																
H5253	004	1	01	01	1	1	2	2			2			2		2		01000	2	2																						Transplant Services	2	2				2			2			2		1	1500.00	10000	2																																									
H9101	001	1	10	05	2			2			2			2		2		00101	1	1	1	1	1			2				2			2			2		1	15.00	00111	1	Chronic Care Services Benefit	1	1	7800.00	3	2	2			1	20	2	2		1	12.00	00001	2																			Member To member Volunteer Services	1	2				2			2			2		2		01000	2					
H9103	001	1	10	05	1	1	2	2			2			2		2		00111	1	2																						Travel	2	1	1000.00	3	1	2			1	20	1	2		2		01000	2	Expanded Care Benefit	2	1	12000.00	3	2	2			1	20	2	2		2		00111	1	Clinical Trials	2	2				2			1	20	4	1	816.00	1	10.00	00111	1					
H9104	006	1	10	05	1	1	1	2			2			2		2		00111	1	2																						Independent Living Power(TM)	1	1	625.00	6	3	1	153.00	6	2			2		1	8.50	10000	1	Custodial Nursing Home Care	1	2				2			2			2		2		00001	1																							
H9104	007	1	10	05	1	1	1	2			2			2		2		00111	1	2																						Independent Living Power(TM)	1	1	625.00	6	3	1	153.00	6	2			2		1	8.50	10000	1	Custodial Nursing Home Care	1	2				2			2			2		2		00001	1																							
H9104	008	1	10	05	1	1	1	2			2			2		2		00111	1	2																						Independent Living Power(TM)	1	1	625.00	6	3	1	153.00	6	2			2		1	8.50	10000	1	Custodial Nursing Home Care	1	2				2			2			2		2		00001	1																							
H9104	009	1	10	05	1	1	1	2			2			2		2		00111	1	2																						Independent Living Power(TM)	1	1	625.00	6	3	1	153.00	6	2			2		1	8.50	10000	1	Custodial Nursing Home Care	1	2				2			2			2		2		00001	1																							
