business_year | state_code | issuer_id | source_name | version_number | import_date | issuer_id_repeated | state_code_repeated | plan_id | plan_id_standard_component_id_with_variant | benefit_name | copay_in_network_tier_1 | copay_in_network_tier_2 | copay_out_of_network | coinsurance_in_network_tier_1 | coinsurance_in_network_tier_2 | coinsurance_out_of_network | ehb_indicator | state_required_benefit_indicator | is_this_benefit_covered | quantitative_limit_on_service | limit_quantity | limit_unit | minimum_stay | exclusions | benefit_explanation | ehb_variance_reason | is_subject_to_deductible_tier_1 | is_subject_to_deductible_tier_2 | is_excluded_from_in_network_moop | is_excluded_from_out_of_network_moop | _row_number |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2014 | WI | 47342 | HIOS | 11 | 07/25/2014 04:54:18 PM | 47342 | WI | 47342WI0050012 | 47342WI0050012-03 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | FL | 48121 | HIOS | 12 | 10/15/2013 07:27:56 AM | 48121 | FL | 48121FL0020011 | 48121FL0020011-00 | Bariatric Surgery | 79 | ||||||||||||||||||||
2014 | FL | 56503 | HIOS | 6 | 03/19/2014 07:06:49 AM | 56503 | FL | 56503FL1400001 | 56503FL1400001-02 | Infertility Treatment | 69 | ||||||||||||||||||||
2014 | OH | 29276 | SERFF | 8 | 07/28/2014 02:39:22 PM | 29276 | OH | 29276OH0740012 | 29276OH0740012-03 | Nutritional Counseling | 127 | ||||||||||||||||||||
2014 | ID | 26002 | SERFF | 6 | 01/22/2014 11:51:12 AM | 26002 | ID | 26002ID0030005 | 26002ID0030005-01 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | NJ | 10191 | HIOS | 7 | 05/02/2014 01:10:05 PM | 10191 | NJ | 10191NJ0060002 | 10191NJ0060002-03 | Diabetes Education | 123 | ||||||||||||||||||||
2014 | FL | 56503 | HIOS | 6 | 03/19/2014 07:06:49 AM | 56503 | FL | 56503FL1410002 | 56503FL1410002-01 | Acupuncture | 100 | ||||||||||||||||||||
2014 | MI | 29241 | SERFF | 7 | 03/18/2014 09:48:59 AM | 29241 | MI | 29241MI0270064 | 29241MI0270064-01 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | IA | 18973 | SERFF | 3 | 11/27/2013 09:24:34 AM | 18973 | IA | 18973IA0210002 | 18973IA0210002-06 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | WI | 94529 | HIOS | 10 | 03/19/2014 07:06:49 AM | 94529 | WI | 94529WI0210005 | 94529WI0210005-00 | Routine Foot Care | 99 | ||||||||||||||||||||
2014 | NC | 11512 | HIOS | 9 | 01/29/2014 08:00:05 AM | 11512 | NC | 11512NC0100034 | 11512NC0100034-03 | Acupuncture | 100 | ||||||||||||||||||||
2014 | OK | 53524 | HIOS | 6 | 11/26/2013 01:14:08 PM | 53524 | OK | 53524OK0050003 | 53524OK0050003-01 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | FL | 48121 | HIOS | 12 | 10/15/2013 07:27:56 AM | 48121 | FL | 48121FL0020005 | 48121FL0020005-06 | Infertility Treatment | 69 | ||||||||||||||||||||
2014 | AL | 77233 | HIOS | 6 | 01/17/2014 09:36:20 AM | 77233 | AL | 77233AL0020002 | 77233AL0020002-01 | Orthodontia - Adult | 114 | ||||||||||||||||||||
2014 | PA | 22444 | HIOS | 9 | 01/21/2014 08:29:49 AM | 22444 | PA | 22444PA0040023 | 22444PA0040023-03 | Radiation | 122 | ||||||||||||||||||||
2014 | ID | 61589 | SERFF | 11 | 01/22/2014 11:51:12 AM | 61589 | ID | 61589ID1690001 | 61589ID1690001-00 | Orthodontia - Adult | 114 | ||||||||||||||||||||
2014 | IA | 27651 | SERFF | 5 | 11/27/2013 09:24:34 AM | 27651 | IA | 27651IA0050007 | 27651IA0050007-05 | Orthodontia - Adult | 114 | ||||||||||||||||||||
2014 | WI | 87416 | HIOS | 6 | 10/15/2013 07:27:56 AM | 87416 | WI | 87416WI0020016 | 87416WI0020016-00 | Acupuncture | 100 | ||||||||||||||||||||
2014 | OH | 77552 | SERFF | 6 | 10/15/2013 10:04:03 AM | 77552 | OH | 77552OH0010064 | 77552OH0010064-06 | Acupuncture | Not Covered | 100 | |||||||||||||||||||
2014 | FL | 56503 | HIOS | 6 | 03/19/2014 07:06:49 AM | 56503 | FL | 56503FL1330003 | 56503FL1330003-03 | Diabetes Education | 123 |