PBP_A_HNUMBER	PBP_A_PLAN_IDENTIFIER	PBP_A_BEN_COV	PBP_A_PLAN_TYPE	ORGTYPE	PBP_B13A_AUTH	PBP_B13A_BENDEC	PBP_B13A_BENDESC_AMO	PBP_B13A_BENDESC_YN	PBP_B13A_COINS_COV_MC	PBP_B13A_COINS_PCT_MC	PBP_B13A_COINS_YN	PBP_B13A_COPAY_MC_AMT	PBP_B13A_COPAY_YN	PBP_B13A_DED_AMT	PBP_B13A_DED_YN	PBP_B13A_MAXENR_AMT	PBP_B13A_MAXENR_PER	PBP_B13A_MAXENR_YN	PBP_B13A_REFER_YN	PBP_B13B_AUTH	PBP_B13B_BENDESC_AMO	PBP_B13B_BENDESC_ENHAN	PBP_B13B_BENDESC_LIM	PBP_B13B_BENDESC_NUMV	PBP_B13B_BENDESC_PER	PBP_B13B_BENDESC_YN	PBP_B13B_COINS_COV	PBP_B13B_COINS_PCT	PBP_B13B_COINS_YN	PBP_B13B_COPAY_AMT	PBP_B13B_COPAY_YN	PBP_B13B_DED_AMT	PBP_B13B_DED_YN	PBP_B13B_MAXENR_AMT	PBP_B13B_MAXENR_PER	PBP_B13B_MAXENR_YN	PBP_B13B_MAXPLAN_AMT	PBP_B13B_MAXPLAN_COV	PBP_B13B_MAXPLAN_PER	PBP_B13B_MAXPLAN_YN	PBP_B13B_REFER_YN	PBP_B13C_AUTH	PBP_B13C_BENDESC_AMO	PBP_B13C_BENDESC_SERVICE	PBP_B13C_COINS_COV	PBP_B13C_COINS_PCT	PBP_B13C_COINS_YN	PBP_B13C_COPAY_AMT	PBP_B13C_COPAY_YN	PBP_B13C_DED_AMT	PBP_B13C_DED_YN	PBP_B13C_MAXENR_AMT	PBP_B13C_MAXENR_PER	PBP_B13C_MAXENR_YN	PBP_B13C_MAXPLAN_AMT	PBP_B13C_MAXPLAN_COV	PBP_B13C_MAXPLAN_PER	PBP_B13C_MAXPLAN_YN	PBP_B13C_REFER_YN	PBP_B13D_AUTH	PBP_B13D_BENDESC_AMO	PBP_B13D_BENDESC_SERVICE	PBP_B13D_COINS_COV	PBP_B13D_COINS_PCT	PBP_B13D_COINS_YN	PBP_B13D_COPAY_AMT	PBP_B13D_COPAY_YN	PBP_B13D_DED_AMT	PBP_B13D_DED_YN	PBP_B13D_MAXENR_AMT	PBP_B13D_MAXENR_PER	PBP_B13D_MAXENR_YN	PBP_B13D_MAXPLAN_AMT	PBP_B13D_MAXPLAN_COV	PBP_B13D_MAXPLAN_PER	PBP_B13D_MAXPLAN_YN	PBP_B13D_REFER_YN	PBP_B13E_AUTH	PBP_B13E_BENDESC_AMO	PBP_B13E_BENDESC_SERVICE	PBP_B13E_COINS_COV	PBP_B13E_COINS_PCT	PBP_B13E_COINS_YN	PBP_B13E_COPAY_AMT	PBP_B13E_COPAY_YN	PBP_B13E_DED_AMT	PBP_B13E_DED_YN	PBP_B13E_MAXENR_AMT	PBP_B13E_MAXENR_PER	PBP_B13E_MAXENR_YN	PBP_B13E_MAXPLAN_AMT	PBP_B13E_MAXPLAN_COV	PBP_B13E_MAXPLAN_PER	PBP_B13E_MAXPLAN_YN	PBP_B13E_REFER_YN					
H0150	001	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0150	004	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0150	005	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0150	006	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0150	007	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0151	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	002	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	010	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	011	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	012	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0151	013	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0154	001	1	01	01	00110	1	1	1			2		2		2			2	2							2																																																																										
H0302	001	1	01	01	00001			2			2	25.00	1		2			2	1							2																01000	2	Chronic Disease Personal Travel Program			2	15.00	1		2			2	1000.00	4	3	1	1	00001	2	Personal Care Services			2	20.00	1		2			2				2	1	01000	2	MediSun Care Coordination Program			2		2		2			2				2	2					
H0303	013	1	01	01	00110	1	1	1			2		2		2			2	1							2																01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0303	015	1	01	01	00110	1	1	1			2		2		2			2	1							2																01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0303	022	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0303	034	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0303	035	1	01	01	00110	1	1	1			2		2		2			2	1							2																01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0303	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0307	004	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0307	008	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0307	801	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0315	001	1	04	01	00100			2			2		2		2			2	1							2																																																																										
H0316	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0316	002	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H0350	001	1	01	01	00001			2			2		2		2			2	2							2																																																																										
H0351	007	1	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	008	1	01	01	00111	1	1	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	014	1	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	016	2	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	017	2	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	021	2	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	023	1	01	01	00111	1	2	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	025	1	01	01	00111	1	1	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	026	1	01	01	00111	1	1	1			2		2		2			2	1	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0351	801	1	01	01	00111			2	4	20	1		2		2			2	1							2																																																																										
H0354	001	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H0354	009	2	01	01	01000			2			2		2		2			2	2							2																																																																										
H0504	015	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2	10.00	1		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	1	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	016	1	01	01	00111	1	2	1			2		2		2			2	1							2																00111	2	Family Planning			2	10.00	1		2			2				2	1	00111	2	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	2	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	017	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2	10.00	1		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1																							
H0504	018	1	01	01	00111	1	2	1			2		2		2			2	1							2																00111	2	Family Planning			2	10.00	1		2			2				2	1	00111	2	Diaphrams & their Fitting			2	25.00	1		2			2				2	1																							
H0504	019	2	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2	10.00	1		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	1	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	020	2	01	01	00111	1	2	1			2		2		2			2	1							2																00111	2	Family Planning			2	10.00	1		2			2				2	1	00111	2	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	2	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	021	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2		2		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	1	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	022	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2		2		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	1	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0504	023	2	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Family Planning			2		2		2			2				2	1	00111	1	Diaphrams & their Fitting			2	25.00	1		2			2				2	1	01000	1	Silver Sneakers Program			2	12.00	1		2			2				2	2					
H0523	002	1	01	01	01000			2			2		2		2			2	1							2																																																																										
H0523	022	1	01	01	01000			2			2		2		2			2	1							2																																																																										
H0523	025	1	01	01	01000			2			2		2		2			2	1							2																																																																										
H0523	801	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H0524	001	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	002	2	01	01	00110	1	2	1			2		2		2			2	2							2																00110	2	Hospice care for Part B only members			2		2		2			2				2	1																																									
H0524	003	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	006	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	008	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	009	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	010	2	01	01	00110	1	2	1			2		2		2			2	2							2																00110	2	Hospice care for Part B only members			2		2		2			2				2	1																																									
H0524	013	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	014	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	015	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	801	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	802	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H0524	803	2	01	01	00110	1	2	1			2		2		2			2	2							2																00110	2	Hospice care for Part B only members			2		2		2			2				2	1																																									
H0524	804	2	01	01	00110	1	2	1			2		2		2			2	2							2																00110	2	Hospice care for Part B only members			2		2		2			2				2	1																																									
H0532	001	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0532	002	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0538	001	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	002	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	003	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	004	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	005	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	007	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	008	1	01	01	00101			2			2	100.00	1		2			2	1							2																																																																										
H0538	009	1	01	01	00101			2			2		2		2			2	1							2																																																																										
H0538	802	1	01	01	00101			2	2	13	1		2		2			2	1							2																																																																										
H0540	001	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H0540	005	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H0540	007	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H0540	009	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H0540	010	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H0543	001	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0543	004	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0543	007	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0543	013	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	019	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	022	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	026	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	028	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	029	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	032	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	035	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	036	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	038	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	040	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	046	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	049	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	050	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0543	060	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	065	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0543	070	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	071	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	072	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	073	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	074	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	075	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	076	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	077	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	078	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	079	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	080	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	081	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0543	082	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	802	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0543	803	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0544	001	1	05	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0545	001	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0545	002	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0545	005	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H0562	002	1	01	01	00101	1	1	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	009	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	010	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	011	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	012	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	017	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	019	2	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	029	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	031	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	032	1	01	01	00101	1	1	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	033	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	036	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	037	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	039	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	040	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	041	1	01	01	00101	1	1	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	042	1	01	01	00101	1	1	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	043	1	01	01	00101	1	1	1			2		2		2			2	1	10000	1	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0562	801	1	01	01	00101	1	2	1			2		2		2			2	1	10000	3	1	2	30	3	1			2	10.00	1		2			2				2	2																																																											
H0564	003	1	02	01	00100	1	2	1			2		2		2			2	1							2																																																																										
H0564	004	1	02	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0564	005	1	02	01	00100	1	2	1			2		2		2			2	1							2																																																																										
H0564	006	1	02	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H0564	007	1	02	01	00100	1	2	1			2		2		2			2	1							2																																																																										
H0564	009	1	02	01	00100	1	2	1			2		2		2			2	1							2																																																																										
H0564	023	2	02	01	00100	1	2	1			2		2		2			2	1							2																																																																										
H0564	801	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0564	802	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0564	803	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0564	804	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0564	805	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0564	807	1	02	01	10100	1	2	1			2		2		2			2	1							2																																																																										
H0571	001	1	01	01	01000	1	1	1			2		2		2			2	1	01000	1	1	1			1			2	7.00	1		2			2				2	1																																																											
H0571	002	2	01	01	01000	1	1	1			2		2		2			2	1	01000	1	1	1			1			2	7.00	1		2			2				2	1																																																											
H0571	801	1	01	01	01000	1	1	1			2		2		2			2	1	01000	1	1	1			1			2	7.00	1		2			2				2	1																																																											
H0609	002	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0609	003	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0609	006	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0609	007	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0609	008	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0609	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0630	004	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0630	006	1	02	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0630	007	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0630	009	2	02	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0630	801	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H0630	802	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H0710	001	1	04	01	10100			2			2		2		2			2	1							2																																																																										
H0752	002	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H0755	001	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H0755	010	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H0755	011	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H0755	012	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H0755	013	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H0755	014	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H1013	011	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	25.00	1	5	1	2																																									
H1013	012	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H1013	019	2	01	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H1013	021	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	25.00	1	5	1	2																																									
H1016	001	1	01	01	00111			2			2	0.00	1		2			2	1							2																																																																										
H1016	002	1	01	01	00111			2			2	0.00	1		2			2	1							2																																																																										
H1016	017	2	01	01	00111			2			2	0.00	1		2			2	1							2																																																																										
H1016	018	1	01	01	00111			2			2	0.00	1		2			2	1							2																																																																										
H1019	001	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	002	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	004	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	005	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	006	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	007	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	008	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																10000	1	Emergency Response System			2	25.00	1		2			2				2	2	10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	010	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																																		10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1019	011	1	01	01	00111	1	1	1			2	0.00	1		2			2	1							2																																		10000	1	Over the Counter Medications and Health Maintenance			2		2		2			2	25.00	3	5	1	2																							
H1026	001	1	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1026	002	1	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1026	004	1	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1026	008	2	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1026	009	2	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1026	011	2	01	01	01000	1	1	1			2		2		2			2	1							2																00001	1	Allergy Injections			2	5.00	1		2			2				2	1	01000	1	SilverSneakers Fitness Program			2		2		2			2				2	2																							
H1032	002	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	004	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	006	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	008	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	010	1	01	01	00101			2			2		2		2			2	1							2																10000	1	Over The Counter			2		2		2			2	25.00	5	6	1	2																																									
H1032	012	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	014	1	01	01	00101			2			2		2		2			2	1	01000	1	1	2	6	6	1			2	10.00	1		2			2				2	2	01000	1	OTC			2		2		2			2	25.00	3	6	1	2	01000	1	Dietetic Counseling			2	10.00	1		2			2				2	2	01000	1	Massage Therapy			2	10.00	1		2			2				2	2					
H1032	019	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	021	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	25.00	3	6	1	2																																									
H1032	025	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	10.00	3	6	1	2																																									
H1032	028	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	10.00	3	6	1	2																																									
H1032	029	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	10.00	3	6	1	2																																									
H1032	030	1	01	01	00101			2			2		2		2			2	1							2																01000	1	OTC			2		2		2			2	10.00	3	6	1	2																																									
H1032	031	1	01	01	00101			2			2		2		2			2	1							2																10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H1032	032	1	01	01	00101			2			2		2		2			2	1							2																10000	1	Over The Counter			2		2		2			2	25.00	5	6	1	2																																									
H1032	033	1	01	01	00101			2			2		2		2			2	1							2																01000	1	Over-the-Counter			2		2		2			2	10.00	3	6	1	2																																									
H1034	001	1	01	01	00101			2			2		2		2			2	1							2																																																																										
H1034	003	1	01	01	00101			2			2		2		2			2	1							2																																																																										
H1034	004	1	01	01	00101			2			2		2		2			2	1							2																																																																										
H1035	002	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H1035	004	2	01	01	00111			2			2		2		2			2	1							2																																																																										
H1035	005	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H1036	011	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	016	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	025	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	034	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	035	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	037	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	040	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	044	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	047	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	048	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	050	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	052	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	053	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	054	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	055	1	01	01	00111	1	1	1			2		2		2			2	1							2																01000	1	Over the counter benefit			2		2		2			2	10.00	5	6	1	2																																									
H1036	056	1	01	01	00111	1	1	1			2		2		2			2	1							2																01000	1	Over the counter benefit			2		2		2			2	10.00	5	6	1	2																																									
H1036	058	1	01	01	00111	1	1	1			2		2		2			2	1							2																01000	1	Over the counter benefit			2		2		2			2	10.00	5	6	1	2																																									
H1036	059	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	060	1	01	01	00111	1	1	1			2		2		2			2	1							2																01000	1	Over the counter benefit			2		2		2			2	10.00	5	6	1	2																																									
H1036	061	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	062	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	063	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	065	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	066	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	067	1	01	01	00111	1	1	1			2		2		2			2	1							2																01000	1	Over the counter benefit			2		2		2			2	10.00	5	6	1	2																																									
H1036	068	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	801	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	802	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1036	803	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1045	001	1	05	01	01000			2			2		2		2			2	2							2																01000	1	Over the Counter Program			2		2		2			2	15.00	3	6	1	2																																									
H1076	003	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H1076	010	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	25.00	1	5	1	2																																									
H1076	011	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	50.00	1	5	1	2																																									
H1076	012	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H1076	013	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	25.00	1	5	1	2																																									
H1076	016	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Over The Counter Benefit			2		2		2			2	25.00	1	5	1	2																																									
H1076	018	2	01	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H1078	001	1	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1078	002	2	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1078	003	1	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1078	007	1	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1078	008	1	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1078	009	1	01	01	00001			2			2		2		2			2	1							2																01000	1	Vitamins			2		2		2			2	15.00	3	5	1	2																																									
H1080	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	011	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	013	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	024	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	025	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	026	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	027	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	028	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1080	029	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1099	001	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1099	006	1	01	01	00111	1	1	1	2	15	1		2		2			2	1							2																																																																										
H1170	002	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H1170	005	2	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H1230	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1230	002	2	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1350	001	1	01	01	01000	1	2	1			2		2		2			2	2							2																01000	2	Travel Benefit			2	20.00	1		2			2	3000.00	4	3	1	2																																									
H1350	802	1	01	01	01000	1	2	1			2		2		2			2	2							2																01000	2	Travel Benefit			2	20.00	1		2			2	3000.00	4	3	1	2																																									
H1406	006	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1406	007	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1406	013	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1406	014	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1406	801	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H1463	001	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H1468	004	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H1804	001	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	002	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	003	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	004	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	005	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	006	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	007	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	008	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	009	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	010	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	011	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	012	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	013	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	014	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	015	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	016	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	017	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	018	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	019	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	020	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	801	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1804	802	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H1849	005	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H1849	006	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H1849	009	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H1903	001	1	01	01	00101			2			2		2		2			2	1							2																10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H1951	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1951	005	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1951	006	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H1951	801	1	01	01	01000	1	1	1	2	20	1		2		2			2	2							2																																																																										
H1961	001	1	01	01	00101	1	1	1			2		2		2			2	1							2																00101	1	Organ Transplants			2		2		2			2				2	1																																									
H2108	001	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2	00001	1	Massage Therapy			2		2		2	0.00	6	1				2	2	00001	1	Nursing Home Assessment			2		2		2			2				2	2					
H2108	002	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2	00001	1	Massage Therapy			2		2		2	0.00	6	1				2	2																							
H2108	004	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2	00001	1	Massage Therapy			2		2		2	0.00	6	1				2	2																							
H2108	005	1	01	01	00001			2	4	20	1		2		2			2	1							2																																																																										
H2204	007	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2206	003	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2206	013	2	01	01	01000	1	2	1			2	0.00	1		2			2	2							2																																																																										
H2256	001	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	002	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	005	2	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	006	1	01	01	00101	1	1	1			2		2		2			2	1							2																																																																										
H2256	008	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	009	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	010	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	012	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	013	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	014	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2256	801	1	01	01	00101	1	2	1			2		2		2			2	1							2																																																																										
H2261	005	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2261	007	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2261	008	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2261	009	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2261	010	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2312	004	1	01	01	00101	1	1	1			2		2		2			2	1							2																																																																										
H2354	001	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2354	007	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2354	008	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2354	009	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2354	012	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H2406	001	1	04	01	00100			2			2		2		2			2	1							2																																																																										
H2408	001	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H2408	002	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H2408	003	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H2408	004	1	09	04	01000	1	1	1			2		2		2			2	2							2																																																																										
H2459	001	1	02	01	00100	1	1	1			2		2		2			2	2							2																																																																										
H2459	002	1	02	01	00100	1	1	1			2		2		2			2	2							2																																																																										
H2610	001	1	01	01	01000	1	1	1			2		2		2			2	1							2																																																																										
H2649	004	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H2649	011	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H2649	012	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H2649	801	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H2649	805	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H2654	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	005	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	010	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	013	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	014	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	015	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	016	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	017	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	018	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2654	019	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2663	002	1	01	01	00100	1	2	1			2		2		2			2	2							2																																																																										
H2663	003	2	01	01	00100	1	2	1			2		2		2			2	2							2																																																																										
H2663	005	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H2663	801	1	01	01	00100	1	2	1			2		2		2			2	2							2																																																																										
H2667	001	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H2667	003	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H2667	005	1	01	01	00110	1	2	1			2		2		2			2	2							2																																																																										
H2672	001	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H2672	002	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H2672	801	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H2802	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2802	003	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2803	001	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2803	002	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2803	003	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2803	004	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H2931	002	1	02	01	00111			2			2		2		2			2	1							2																																																																										
H2931	004	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H2931	006	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H2931	008	2	01	01	00111			2			2		2		2			2	1							2																																																																										
H2931	801	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H2949	002	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H2949	005	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H2949	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H2960	004	1	02	01	01000	1	1	1	2	20	1		2		2			2	1							2																																																																										
H3107	001	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H3107	004	1	01	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3107	005	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3107	006	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3112	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3152	022	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3152	029	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3152	037	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3152	801	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3152	803	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3154	003	1	01	01	01000	1	2	1	2	15	1		2		2			2	1							2																00001	2	Miscellaneous	2	15	1	10.00	1		2			2				2	1																																									
H3156	021	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3156	801	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3164	003	1	01	01	01000	1	1	1			2	0.00	1		2			2	2							2																00001	1	Adult Day Care			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Personal Medical Emergency Response System			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Home Assessment and Adaptation Services			2	0.00	1		2			2	500.00	5	3	1	2					
H3204	001	1	01	01	00111			2			2		2		2			2	2							2																00111	3	TravelCare	2	20	1		2	840.00	1			2				2	2	00111	1	Insulin			2	20.00	1		2			2				2	2																							
H3204	004	2	01	01	00111			2			2		2		2			2	2							2																00111	3	TravelCare	2	20	1		2	840.00	1			2				2	2	00111	1	Insulin			2	20.00	1		2			2				2	2																							
H3204	006	1	01	01	00111			2			2		2		2			2	2							2																00111	3	TravelCare	2	20	1		2	840.00	1			2				2	2	00111	1	Insulin			2	20.00	1		2			2				2	2																							
H3204	801	1	01	01	00111			2			2		2		2			2	2							2																00111	3	TravelCare	2	20	1		2	840.00	1			2				2	2	00111	1	Insulin			2	20.00	1		2			2				2	2																							
H3251	002	1	01	01	00111	1	1	1			2		2		2			2	2							2																10000	1	Alternative/Complimentary Medicine Benefit			2	20.00	1		2			2	1500.00	2	3	1	2																																									
H3251	018	1	01	01	00111	1	1	1			2		2		2			2	2							2																																																																										
H3305	001	1	01	01	01000	1	2	1			2		2		2			2	2							2																00101	1	Travel	4	30	1		2		2			2	3000.00	4	3	1	1																																									
H3305	007	1	01	01	01000	1	2	1			2		2		2			2	2							2																00101	1	Travel	4	30	1		2		2			2	3000.00	4	3	1	1																																									
H3305	801	1	01	01	01000	1	2	1			2		2		2			2	2							2																00101	1	Travel	4	30	1		2		2			2	3000.00	4	3	1	1																																									
H3307	002	1	01	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	004	1	02	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	008	2	01	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	010	1	01	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	011	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	012	1	01	01	00001	1	1	1			2		2		2			2	2							2																00100	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3307	013	1	01	01	00001	1	1	1			2		2		2			2	2							2																01000	1	Nutrition Health Benefit			2		2		2			2				2	2	01000	1	Fitness Benefit			2		2		2			2				2	2																							
H3312	002	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	018	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	025	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	026	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	027	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	801	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3312	803	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3328	001	1	01	01	00001			2			2		2		2			2	1							2																																																																										
H3330	003	1	01	01	01000	1	1	1			2		2		2			2	1							2																																																																										
H3330	004	1	01	01	01000	1	2	1			2		2		2			2	1							2																																																																										
H3330	005	1	01	01	01000	1	2	1			2		2		2			2	1							2																																																																										
H3330	006	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3330	007	1	01	01	00001	1	2	1			2		2		2			2	1							2																																																																										
H3330	008	1	01	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H3330	009	1	01	01	01000	1	1	1			2		2		2			2	1							2																																																																										
H3330	010	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3330	011	2	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3330	020	1	01	01	00001	1	1	1			2		2		2			2	2							2																																																																										
H3330	801	1	01	01	00001			2	4	20	1		2		2			2	1							2																																																																										
H3333	001	1	09	04	01000			2			2		2		2			2	2							2																																																																										
H3333	002	1	09	04	01000			2			2		2		2			2	2							2																																																																										
H3333	003	1	09	04	01000			2			2		2		2			2	2							2																																																																										
H3333	004	1	09	04	01000			2			2		2		2			2	2							2																																																																										
H3335	002	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	003	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	004	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3335	005	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	006	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	007	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	008	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	009	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	010	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	011	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	012	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	013	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	014	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	015	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	016	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	017	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	018	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	801	1	04	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3335	802	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	803	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	804	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	805	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3335	806	1	04	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3351	001	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3351	002	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3351	004	2	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3351	006	1	01	01	00111	1	2	1			2		2		2			2	1							2																00111	1	Travel Benefit	2	20	1		2	100.00	1			2	5000.00	2	3	1	2																																									
H3351	007	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Travel Benefits	2	20	1		2	100.00	1			2	5000.00	2	3	1	2																																									
H3351	008	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Travel Benefit	2	20	1		2	100.00	1			2	5000.00	2	3	1	2																																									
H3351	009	1	01	01	00111	1	2	1			2		2		2			2	1							2																10000	2	Travel Benefit	2	20	1		2	100.00	1			2	5000.00	2	3	1	2																																									
H3351	801	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3351	802	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Travel Benefits	2	20	1		2	100.00	1			2	5000.00	2	3	1	2																																									
H3359	001	1	01	01	01000			2			2	0.00	1		2			2	1							2																01000	1	CMS Approved Drug Discount Card Enrollment Fee Coverage			2		2		2			2	30.00	5	3	1	2																																									
H3359	019	1	01	01	01000			2			2	0.00	1		2			2	1							2																01000	1	Prescription Drugs Reimbursement			2		2		2			2	240.00	5	3	1	2	01000	1	CMS Approved Drug Discount Card Enrollment Fee Coverage			2		2		2			2	30.00	5	3	1	2																							
H3359	021	1	01	01	01000			2	2	0	1		2		2			2	1							2																01000	1	Initial Home Assessment			2	0.00	1		2			2				2	2	00001	1	Home Health Safety Improvement			2	0.00	1		2			2	500.00	5	6	1	2	01000	1	Non-prescription drugs			2	0.00	1		2			2	100.00	2	5	1	2					
H3359	801	1	01	01	01000			2			2	0.00	1		2			2	1							2																																																																										
H3359	802	1	01	01	01000			2			2	0.00	1		2			2	1							2																																																																										
H3361	019	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	35.00	1		2			2				2	1																																																											
H3361	020	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	20.00	1		2			2				2	1	10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H3361	021	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	35.00	1		2			2				2	1	10000	1	Over-the-Counter			2		2		2			2	10.00	3	6	1	2																																									
H3361	022	1	01	01	00101			2			2		2		2			2	1	00101	2	1	1			1			2	35.00	1		2			2				2	1																																																											
H3361	023	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	20.00	1		2			2				2	1	10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H3361	024	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	20.00	1		2			2				2	1	10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H3361	025	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	20.00	1		2			2				2	1	10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H3361	026	1	01	01	00101			2			2		2		2			2	1	00101	2	1	1			1			2	35.00	1		2			2				2	1																																																											
H3361	027	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	25.00	1		2			2				2	1	10000	1	Over-the-Counter			2		2		2			2	10.00	3	6	1	2																																									
H3361	028	1	01	01	00101			2			2		2		2			2	1	00101	2	1	1			1			2	35.00	1		2			2				2	1																																																											
H3361	029	1	01	01	00101			2			2		2		2			2	1	00101	2	1	1			1			2	25.00	1		2			2				2	1																																																											
H3361	030	1	01	01	00101			2			2		2		2			2	1	00101	1	1	1			1			2	30.00	1		2			2				2	1	10000	1	Over The Counter			2		2		2			2	10.00	5	6	1	2																																									
H3361	031	1	01	01	00101			2	2	20	1		2		2			2	1							2																10000	1	Over-The-Counter			2		2		2			2	25.00	5	6	1	2	10000	1	Home Safety Assessment			2		2		2			2	225.00	3	6	1	2	10000	1	Home Safety Items			2		2		2			2	250.00	3	3	1	2					
H3361	032	1	01	01	00101			2	3	20	1		2		2			2	1							2																10000	1	Over-The-Counter			2		2		2			2	25.00	5	6	1	2	10000	1	Home Safety Assessment			2		2		2			2	225.00	3	6	1	2	10000	1	Home Safety Items			2		2		2			2	250.00	3	3	1	2					
H3361	034	1	01	01	00101			2	2	20	1		2		2			2	1							2																10000	1	Over-The-Counter			2		2		2			2	25.00	5	6	1	2	10000	1	Home Safety Assessment			2		2		2			2	225.00	3	6	1	2	10000	1	Home Safety Items			2		2		2			2	250.00	3	3	1	2					
H3361	035	1	01	01	00101			2	2	20	1		2		2			2	1							2																10000	1	Over-The-Counter			2		2		2			2	25.00	5	6	1	2	10000	1	Home Safety Assessment			2		2		2			2	225.00	3	6	1	2	10000	1	Home Safety Items			2		2		2			2	250.00	3	3	1	2					
H3362	003	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	013	2	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	802	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	803	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	804	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	805	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3362	806	1	01	01	01000	1	1	1			2		2		2			2	2							2																00101	1	Travel Benefit			2	20.00	1		2			2	1500.00	4	3	1	2																																									
H3366	001	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	005	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	007	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	008	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	009	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	010	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	011	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	012	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	013	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	014	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	015	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3366	016	1	01	01	00001	1	1	1			2		2		2			2	1							2																																																																										
H3370	001	1	01	01	01000			2			2	0.00	1		2			2	2							2																																																																										
H3370	002	1	01	01	01000			2			2	0.00	1		2			2	2							2																																																																										
H3370	003	1	01	01	01000			2			2	0.00	1		2			2	2							2																																																																										
H3370	004	1	01	01	01000			2			2	0.00	1		2			2	2							2																																																																										
H3370	005	1	01	01	01000			2			2	0.00	1		2			2	2							2																																																																										
H3379	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	002	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	005	1	01	01	01000	1	1	1			2		2		2			2	2	01000	2	1	2	6	3	1			2	5.00	1		2			2				2	2																																																											
H3379	007	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	010	1	01	01	01000	1	1	1			2		2		2			2	2	01000	2	1	2	6	3	1			2	5.00	1		2			2				2	2																																																											
H3379	011	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	012	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	013	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	014	1	01	01	01000	1	1	1			2		2		2			2	2	01000	2	1	2	6	3	1			2	5.00	1		2			2				2	2																																																											
H3379	015	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	016	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3379	017	1	01	01	01000	1	1	1			2		2		2			2	2	01000	2	1	2	6	3	1			2	5.00	1		2			2				2	2																																																											
H3384	013	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3384	015	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3384	019	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3384	022	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3387	005	1	01	01	01000	1	1	1			2	0.00	1		2			2	2							2																00001	1	Adult Day Care			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Personal Medical Emergency Response System			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Home Assessment and Adaptation Services			2	0.00	1		2			2	500.00	5	3	1	2					
H3387	006	1	01	01	01000	1	1	1			2	0.00	1		2			2	2							2																00001	1	Adult Day Care			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Personal Medical Emergency Response System			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Home Assessment and Adaptation Services			2	0.00	1		2			2	500.00	5	3	1	2					
H3388	001	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3449	004	2	01	01	01000			2			2		2		2			2	2							2																																																																										
H3449	005	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3456	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	006	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	007	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	008	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	010	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3456	011	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	012	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3456	013	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	005	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	006	2	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	007	2	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	008	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3653	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3655	001	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	011	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	012	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	013	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	016	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	017	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	027	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	028	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3655	029	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3657	009	1	01	01	00100			2			2		2		2			2	2							2																																																																										
H3657	010	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3659	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	002	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	003	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	007	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	017	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	018	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	029	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	031	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	032	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	033	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	034	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	035	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	036	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	037	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	038	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	039	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	040	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	041	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	042	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	043	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	044	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3659	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3660	003	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3660	010	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3664	001	1	01	01	00111			2			2		2		2			2	2							2																																																																										
H3664	003	1	01	01	00111			2			2		2		2			2	2							2																																																																										
H3664	004	1	01	01	00111			2			2		2		2			2	2							2																																																																										
H3664	008	2	01	01	00111			2			2		2		2			2	2							2																																																																										
H3664	009	1	01	01	00111			2			2		2		2			2	2							2																																																																										
H3668	005	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3672	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3672	003	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3672	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3672	010	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3673	801	1	01	01	00111	1	2	1			2		2		2			2	2							2																																																																										
H3706	001	1	01	01	00101			2			2		2		2			2	1							2																																																																										
H3749	001	1	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H3749	004	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H3749	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H3755	001	1	01	01	00111	1	1	1			2		2		2			2	1							2																00111	1	Pulmonary Rehabilitation			2		2		2			2				2	1																																									
H3805	001	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H3805	005	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H3805	007	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H3805	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H3856	007	2	01	01	00100			2			2		2		2			2	1							2																																																																										
H3856	010	1	01	01	00100			2			2		2		2			2	1							2																																																																										
H3864	001	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3864	002	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H3864	005	1	02	01	01000			2			2		2		2			2	2							2																																																																										
H3907	001	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	002	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	003	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	005	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	006	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	007	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	009	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	010	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	015	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	016	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	017	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	018	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3907	801	1	01	01	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3912	001	1	04	01	00100			2			2		2		2			2	1							2																																																																										
H3912	002	1	04	01	00100			2			2		2		2			2	1							2																																																																										
H3916	001	1	04	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H3916	002	1	04	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H3916	003	1	04	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H3916	004	1	04	01	00001	1	2	1			2		2		2			2	2							2																																																																										
H3931	004	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	019	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	054	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	055	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	056	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	057	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	801	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3931	803	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3949	002	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2																																									
H3949	007	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2																																									
H3949	008	1	01	01	00001			2	4	20	1		2		2			2	1							2																00001	1	Nurse Practicioner Office Visits			2		2		2			2				2	2																																									
H3952	008	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	009	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	018	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	020	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	024	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	025	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	026	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	027	1	02	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	801	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3952	802	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H3954	003	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	004	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	005	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	006	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	007	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	008	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H3954	009	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	010	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	011	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	012	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	013	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	014	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3954	015	1	01	01	00111			2	3	10	1		2		2			2	1							2																																																																										
H3957	003	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	006	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	008	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	016	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	020	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	021	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	022	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3957	023	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H3959	001	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H3959	002	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H3959	004	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3959	006	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3959	008	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3959	010	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H3959	011	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H3959	801	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3962	001	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3962	002	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3962	003	1	01	01	00111	1	2	1			2		2		2			2	1							2																																																																										
H3964	001	1	01	01	01000			2			2		2		2			2	2							2																00001	1	Home Smoke Alarm Benefit			2		2		2			2				2	2																																									
H3964	002	1	01	01	01000			2			2		2		2			2	2							2																00001	1	Home Medical & Safety Assessment			2		2		2			2				2	2	00001	1	Home Safety Improvement & Home Smoke Alarm Benefit			2		2		2			2	600.00	5	6	1	2	00001	1	Over the Counter Drug Benefit			2		2		2			2	35.00	2	6	1	2					
H3972	001	1	01	01	01000	1	1	1			2	0.00	1		2			2	2							2																00001	1	Adult Day Care			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Personal Medical Emergency Response System			2	20.00	1		2			2	500.00	5	3	1	2	00001	1	Home Assessment and Adaptation Services			2	0.00	1		2			2	500.00	5	3	1	2					
H4003	001	1	01	01	00001			2			2		2		2			2	1							2																01000	3	Travel  Benefit			2		2		2			2	2000.00	4	3	1	2																																									
H4003	801	1	01	01	00001			2			2		2		2			2	1							2																																																																										
H4004	001	1	01	01	00001			2			2		2		2			2	2							2																																																																										
H4004	002	1	01	01	00001			2			2		2		2			2	2							2																																																																										
H4004	003	1	01	01	00110			2			2		2		2			2	2							2																																																																										
H4102	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H4102	008	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H4102	013	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H4102	014	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H4102	017	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H4152	004	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H4152	005	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H4152	007	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H4454	002	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4454	007	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4456	005	1	01	01	00110	1	1	1			2		2		2			2	2							2																																																																										
H4456	006	1	01	01	00110	1	1	1			2		2		2			2	2							2																																																																										
H4456	801	1	01	01	00110	1	1	1			2		2		2			2	2							2																																																																										
H4456	805	1	01	01	00110	1	1	1			2		2		2			2	2							2																00111	2	Wigs/hairpieces for chemotherapy patients			2		2		2			2	500.00	2	3	1	2	00111	2	Custodial Care/Private Duty Nursing			2		2		2			2	6000.00	2	6	1	2																							
H4461	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4461	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4461	007	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4461	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4461	802	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4461	803	1	01	01	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4506	002	1	05	01	01000			2			2		2		2			2	2							2																																																																										
H4506	003	1	05	01	00001			2			2		2		2			2	1							2																																																																										
H4506	004	1	05	01	00001			2			2		2		2			2	1							2																																																																										
H4506	005	1	05	01	00001			2			2		2		2			2	1							2																																																																										
H4506	801	1	05	01	00001			2			2		2		2			2	1							2																																																																										
H4506	802	1	05	01	00001			2			2		2		2			2	1							2																																																																										
H4510	006	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H4510	012	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H4510	015	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H4510	801	1	01	01	00111	1	1	1			2		2		2			2	1							2																																																																										
H4513	001	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	006	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	007	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	009	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	010	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	011	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	012	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4513	013	1	01	01	00100	1	1	1			2		2		2			2	1							2																																																																										
H4514	001	1	01	01	00100			2			2		2		2			2	1							2																																																																										
H4590	010	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H4590	012	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H4590	013	2	01	01	00110	1	1	1			2		2		2			2	1							2																																																																										
H4590	020	1	01	01	00110	1	1	1			2		2		2			2	1	00110	1	1	2	12	3	1			2	5.00	1		2			2				2	1	01000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H4590	021	1	01	01	00110	1	1	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H4590	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H5005	001	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H5005	003	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H5005	008	2	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H5005	010	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H5005	011	1	01	01	00110	1	2	1			2		2		2			2	1							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H5005	801	1	01	01	00110	1	2	1			2		2		2			2	1							2																																																																										
H5006	001	1	09	04	01000			2	1	15	1		2		2			2	2							2																																																																										
H5006	004	1	09	04	01000			2	1	15	1		2		2			2	2							2																																																																										
H5006	005	1	09	04	01000			2	1	15	1		2		2			2	2							2																																																																										
H5050	001	1	02	01	00111			2			2		2		2			2	1							2																00111	2	Home IV Drug Therapy			2		2		2			2				2	1																																									
H5050	002	1	02	01	00111			2			2		2		2			2	1							2																00111	2	Home IV Drug Therapy			2		2		2			2				2	1																																									
H5050	004	1	02	01	00111			2			2		2		2			2	1							2																																																																										
H5050	005	2	02	01	00111			2			2		2		2			2	1							2																00111	2	Home IV Drug Therapy			2		2		2			2				2	1																																									
H5050	006	2	02	01	00111			2			2		2		2			2	1							2																																																																										
H5149	801	1	01	01	00111	1	2	1			2		2		2			2	2							2																																																																										
H5151	002	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5151	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5211	001	1	02	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5253	004	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5253	006	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5253	007	1	01	01	01000			2			2		2		2			2	2							2																																																																										
H5253	008	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H5262	001	1	01	01	01000	1	2	1			2		2		2			2	2							2																																																																										
H5402	001	1	01	01	00100			2			2		2		2			2	1							2																00101	1	Non -Prescription Over the Counter Drugs			2		2		2			2	20.00	2	5	1	2																																									
H5402	002	1	01	01	00100			2			2		2		2			2	1							2																00101	1	Non-Prescription Over the Counter Drugs			2		2		2			2	10.00	2	5	1	2																																									
H5402	006	1	01	01	00100			2			2		2		2			2	1							2																00101	1	Non-prescription Over The Conter Drugs			2		2		2			2	10.00	2	5	1	2																																									
H5404	001	1	01	01	01000			2	4	20	1		2		2			2	2							2																																																																										
H5404	002	1	01	01	01000			2	4	20	1		2		2			2	2							2																																																																										
H5404	003	1	01	01	01000			2	4	20	1		2		2			2	2							2																																																																										
H5404	004	1	01	01	01000			2	4	20	1		2		2			2	2							2																																																																										
H5407	001	1	01	01	00111			2			2		2		2			2	1							2																																																																										
H9001	001	1	01	01	00111	1	2	1			2		2		2			2	1							2																01000	2	Weight Watchers			2		2		2			2				2	2																																									
H9001	004	1	01	01	00111	1	2	1			2		2		2			2	1							2																01000	2	Weight Watchers			2		2		2			2				2	2																																									
H9001	006	1	01	01	00111	1	2	1			2		2		2			2	1							2																01000	2	Weight Watchers			2		2		2			2				2	2																																									
H9001	007	1	01	01	00111	1	2	1			2		2		2			2	1							2																01000	2	Weight Watchers			2		2		2			2				2	2																																									
H9003	001	1	01	01	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel Benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	visiting member			2		2		2			2				2	2																							
H9003	002	1	01	01	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel Benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	visiting member			2		2		2			2				2	2																							
H9003	003	2	01	01	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel Benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	visiting member			2		2		2			2				2	2	00110	2	hospice			2		2		2			2				2	1					
H9003	005	1	01	01	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel Benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	visiting member			2		2		2			2				2	2																							
H9003	801	1	01	01	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel Benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	visiting member			2		2		2			2				2	2																							
H9005	004	1	01	01	00110	1	2	1			2		2		2			2	1	00100	2	1	1			1			2	10.00	1		2			2				2	1																																																											
H9011	003	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9011	009	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9011	010	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9011	011	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9011	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9016	002	1	01	01	00100			2			2		2		2			2	1							2																																																																										
H9016	004	2	01	01	00100			2			2		2		2			2	1							2																																																																										
H9016	006	1	01	01	00100			2			2		2		2			2	1							2																																																																										
H9047	001	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9047	013	2	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9047	022	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9047	024	1	01	01	01000	1	1	1	2	10	1		2		2			2	2							2																																																																										
H9047	801	1	01	01	01000	1	1	1			2		2		2			2	2							2																																																																										
H9049	001	1	01	01	00100			2			2		2		2			2	1							2																																																																										
H0102	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H0103	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H0313	001	1	26	05	01000	1	1	1	5	10	1		2	100.00	1			2	2							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0313	002	1	26	05	01000	1	1	1	5	10	1		2	100.00	1			2	2							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H0314	001	1	26	05	00111	1	2	1			2		2		2			2	2	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0314	002	1	26	05	00111	1	2	1			2		2		2			2	2	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0314	003	1	26	05	00111	1	2	1			2		2		2			2	2	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0314	004	1	26	05	00111	1	2	1			2		2		2			2	2	01000	3	1	2	24	3	1			2	15.00	1		2			2				2	2																																																											
H0357	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H0502	001	1	18	06	01000	1	1	1			2		2		2			2	1							2																00001	1	Hospice			2		2		2			2				2	1																																									
H0502	002	1	18	06	00001	1	1	1			2		2		2			2	1	01000	1	1	2	20	3	1			2		2		2			2				2	2	00001	1	Hospice			2		2		2			2				2	1																																									
H0602	001	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	002	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	003	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	004	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	005	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	006	1	18	06	01000	1	1	1			2		2		2			2	2	01000	1	1	2	10	3	1			2	20.00	1		2			2				2	2																																																											
H0602	007	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	008	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0602	009	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H0619	001	1	22	05	00110	1	2	1			2		2		2			2	1							2																																																																										
H0662	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H0706	001	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H0706	801	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H0706	802	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H1047	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H1047	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H1083	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H1083	002	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H1151	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H1251	001	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1251	002	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1251	003	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1349	001	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H1349	006	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H1349	008	2	18	06	00100			2			2		2		2			2	1							2																																																																										
H1349	010	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H1407	001	1	24	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H1408	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H1412	001	1	26	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H1412	801	1	26	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H1413	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H1472	001	1	18	06	00110	1	1	1			2		2		2			2	2							2																																																																										
H1472	002	1	18	06	00110	1	1	1			2		2		2			2	2							2																																																																										
H1508	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H1508	801	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H1555	001	2	18	06	00001			2			2		2		2			2	1							2																																																																										
H1555	002	2	18	06	00001			2			2		2		2			2	1							2																																																																										
H1555	003	2	18	06	00001			2			2		2		2			2	1							2																																																																										
H1558	003	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1558	004	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H1558	005	2	18	06	00001	1	1	1			2		2		2			2	1							2																																																																										
H1651	001	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1651	002	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1651	003	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H1715	001	1	26	05	00100	1	1	1			2		2		2			2	1							2																																																																										
H1805	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H1901	001	1	26	05	01000			2			2		2		2			2	2							2																01000	1	Organ Transplants			2		2		2			2				2	2																																									
H2110	001	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H2110	801	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H2110	802	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H2150	002	1	18	06	01000			2			2		2		2			2	1							2																																																																										
H2155	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H2259	001	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H2259	004	1	14	05	00100			2			2		2		2			2	1							2																																																																										
H2407	001	1	16	05																																																																																																
H2450	001	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H2450	002	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H2456	002	1	16	05																																																																																																
H2457	002	1	16	05																																																																																																
H2458	002	1	16	05																																																																																																
H2903	001	1	26	05	01000	1	1	1	5	10	1		2	100.00	1			2	2							2																10000	1	A Solution for Caregivers			2		2		2			2				2	2																																									
H2961	002	1	10	05	00111			2			2		2		2			2	1							2																																																																										
H2961	011	1	10	05	00111			2			2		2		2			2	1							2																																																																										
H2961	801	1	10	05	00111			2			2		2		2			2	1							2																																																																										
H3108	001	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3108	002	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3108	801	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3108	802	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3109	001	1	26	05	01000	1	2	1			2		2		2			2	1							2																																																																										
H3109	002	1	26	05	01000	1	2	1			2		2		2			2	1							2																																																																										
H3323	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	002	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	003	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	004	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	801	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	802	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	803	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	804	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	805	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	806	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	807	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3323	808	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3324	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3324	002	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3324	003	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3324	004	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3324	801	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3325	001	1	26	05	01000			2			2	0.00	1		2			2	1							2																01000	1	CMS Approved Drug Discount Card Enrollment Fee Coverage			2		2		2			2	30.00	5	3	1	2																																									
H3325	002	1	26	05	01000			2			2	0.00	1		2			2	1							2																10000	1	CMS Approved Drug Discount Card Enrollment Fee Coverage			2		2		2			2	30.00	5	3	1	2																																									
H3326	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3326	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3403	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3615	001	1	26	05	00111	1	2	1			2		2		2			2	2							2																																																																										
H3615	801	1	26	05	00111	1	2	1			2		2		2			2	2							2																																																																										
H3616	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3616	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3617	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3617	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3618	001	1	26	05	01000			2			2		2		2			2	2							2																																																																										
H3806	001	1	26	05	00001	1	2	1			2		2		2			2	2	00001	2	1	1			1			2	15.00	1		2			2	500.00	2	3	1	2																																																											
H3851	005	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H3851	006	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H3851	007	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H3851	008	1	18	06	00100			2			2		2		2			2	1							2																																																																										
H3851	011	2	18	06	00110			2			2		2		2			2	2							2																																																																										
H3909	001	1	23	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H3909	003	1	23	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H3909	004	1	23	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H3909	801	1	23	05	01000	1	2	1			2		2		2			2	2							2																																																																										
H3911	801	1	21	05	00111	1	2	1			2		2		2			2	2							2																																																																										
H3913	001	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	002	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	003	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	004	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	005	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	006	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3913	801	1	26	05	00111			2			2		2		2			2	2							2																10000	2	Assist America			2		2		2			2				2	2																																									
H3914	001	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3914	002	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3914	801	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3914	802	1	26	05	00111			2			2		2		2			2	2							2																																																																										
H3915	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H3915	801	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H4103	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H4403	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																01000	1	Home Safety Evaluation			2		2		2			2	80.00	2	6	1	2																																									
H4404	001	1	26	05	00100	1	1	1			2		2		2			2	1							2																																																																										
H4564	001	1	18	06	00111	1	2	1			2	0.00	1		2			2	1							2																00111	2	Allergy Injections to include Allergy Serum			2	0.00	1		2			2				2	1																																									
H4564	002	1	18	06	00111	1	2	1			2	0.00	1		2			2	1							2																00111	2	Allergy Injections to include Allergy Serum			2	0.00	1		2			2				2	1																																									
H4564	003	1	18	06	00111			2			2		2		2			2	1							2																00111	2	allergy serum			2	25.00	1		2			2				2	1																																									
H5102	003	1	18	06	01000	1	1	1			2		2		2			2	2							2																																																																										
H5104	801	1	21	05	00111	1	2	1			2		2		2			2	2							2																																																																										
H5105	801	1	21	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H5254	001	1	18	06	00111			2			2		2		2			2	1							2																																																																										
H5256	001	1	18	06	01000			2			2		2		2			2	2							2																																																																										
H5400	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H5400	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H5401	001	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H5401	002	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H5401	003	1	26	05	01000	1	1	1			2		2		2			2	2							2																																																																										
H6360	001	1	18	06	00111	1	2	1			2		2		2			2	1							2																00111	2	Blood Transfusions			2		2		2			2				2	1	00111	2	Transplants			2	250.00	1		2			2				2	1																							
H6360	002	1	18	06	00111	1	2	1			2		2		2			2	1							2																00111	2	Blood Transfusions			2		2		2			2				2	1	00111	2	Transplants			2	500.00	1		2			2				2	1																							
H9101	007	1	10	05	00101			2			2		2		2			2	1	00111	1	1	1			1			2	15.00	1		2			2				2	1	00001	1	Chronic Care Services	2	20	1	12.00	1		2			2	7800.00	2	3	1	2																			01000	1	Member To Member Volunteer Services			2		2		2			2				2	2					
H9103	001	1	10	05	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	Visiting Member			2		2		2			2				2	2	10000	2	Expanded Care Benefit	5	20	1		2		2			2	12000.00	5	3	1	2					
H9103	005	1	10	05	00111	1	2	1			2	15.00	1		2			2	1							2																01000	2	Travel benefit	4	20	1		2		2			2	1000.00	4	3	1	2	01000	2	Visiting Member			2		2		2			2				2	2	10000	2	Expanded Care Benefit	5	20	1		2		2			2	12000.00	5	3	1	2					
H9104	006	1	10	05	00111	1	1	1			2		2		2			2	1							2																10000	1	Independent Living Power (TM)			2	8.50	1		2	153.00	6	1	700.00	3	6	1	1	00001	1	Custodial Nursing Home Care			2		2		2			2	15000.00	2	6	1	1	10000	1	Transportation to Routine Medical and Diagnostic Serv.			2		2		2			2				2	2					
H9104	007	1	10	05	00111	1	1	1			2		2		2			2	1							2																10000	1	Independent Living Power (tm)			2	8.50	1		2	153.00	6	1	700.00	3	6	1	1	00001	1	Custodial Nursing Home Care			2		2		2			2	15000.00	2	6	1	1	10000	1	Transportation to Routine Medical and Diagnostic Serv.			2		2		2			2				2	2					
H9104	008	1	10	05	00111	1	1	1			2		2		2			2	1							2																10000	1	Independent Living Power (TM)			2	8.50	1		2	153.00	6	1	700.00	3	6	1	1	00001	1	Custodial Nursing Home Care			2		2		2			2	15000.00	2	6	1	1	10000	1	Transportation to Routine Medical and Diagnostic Serv.			2		2		2			2				2	2					
H9104	009	1	10	05	00111	1	1	1			2		2		2			2	1							2																10000	1	Independent Living Power (TM)			2	8.50	1		2	153.00	6	1	700.00	3	6	1	1	00001	1	Custodial Nursing Home Care			2		2		2			2	15000.00	2	6	1	1	10000	1	Transportation to Routine Medical and Diagnostic Serv.			2		2		2			2				2	2					
H9104	801	1	10	05	00111	1	1	1			2		2		2			2	1							2																10000	1	Independent Living Power (R)			2	8.50	1		2	153.00	6	1	700.00	3	6	1	1	00001	1	Custodial Nursing Home Care			2		2		2			2	15000.00	2	6	1	1	10000	1	Transportation to Routine Medical and Diagnostic Serv.			2		2		2			2				2	2					
