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Healthcare.gov Dataset Explorer

Healthcare.gov Dataset Explorer

Dataset: 9epp-mpe8

businessyearstatecodeissueridsourcenameimportdatemarketcoveragedentalonlyplantinstandardcomponentidplanmarketingnamehiosproductidhpidnetworkidserviceareaidformularyidisnewplanplantypemetalleveldesigntypeuniqueplandesignqhpnonqhptypeidisnoticerequiredforpregnancyisreferralrequiredforspecialistspecialistrequiringreferralplanlevelexclusionsindianplanvariationestimatedadvancedpaymentamountperenrolleecompositeratingofferedchildonlyofferingchildonlyplanidwellnessprogramoffereddiseasemanagementprogramsofferedehbpercenttotalpremiumehbpediatricdentalapportionmentquantityisguaranteedrateplaneffectivedateplanexpirationdateoutofcountrycoverageoutofcountrycoveragedescriptionoutofserviceareacoverageoutofserviceareacoveragedescriptionnationalnetworkurlforenrollmentpaymentformularyurlplanidplanvariantmarketingnamecsrvariationtypeissueractuarialvalueavcalculatoroutputnumbermedicaldrugdeductiblesintegratedmedicaldrugmaximumoutofpocketintegratedmultipleinnetworktiersfirsttierutilizationsecondtierutilizationsbchavingababydeductiblesbchavingababycopaymentsbchavingababycoinsurancesbchavingababylimitsbchavingdiabetesdeductiblesbchavingdiabetescopaymentsbchavingdiabetescoinsurancesbchavingdiabeteslimitsbchavingsimplefracturedeductiblesbchavingsimplefracturecopaymentsbchavingsimplefracturecoinsurancesbchavingsimplefracturelimitspecialtydrugmaximumcoinsuranceinpatientcopaymentmaximumdaysbeginprimarycarecostsharingafternumberofvisitsbeginprimarycaredeductiblecoinsuranceafternumberofcopaysmehbinntier1individualmoopmehbinntier1familyperpersonmoopmehbinntier1familypergroupmoopmehbinntier2individualmoopmehbinntier2familyperpersonmoopmehbinntier2familypergroupmoopmehboutofnetindividualmoopmehboutofnetfamilyperpersonmoopmehboutofnetfamilypergroupmoopmehbcombinnoonindividualmoopmehbcombinnoonfamilyperpersonmoopmehbcombinnoonfamilypergroupmoopdehbinntier1individualmoopdehbinntier1familyperpersonmoopdehbinntier1familypergroupmoopdehbinntier2individualmoopdehbinntier2familyperpersonmoopdehbinntier2familypergroupmoopdehboutofnetindividualmoopdehboutofnetfamilyperpersonmoopdehboutofnetfamilypergroupmoopdehbcombinnoonindividualmoopdehbcombinnoonfamilyperpersonmoopdehbcombinnoonfamilypergroupmooptehbinntier1individualmooptehbinntier1familyperpersonmooptehbinntier1familypergroupmooptehbinntier2individualmooptehbinntier2familyperpersonmooptehbinntier2familypergroupmooptehboutofnetindividualmooptehboutofnetfamilyperpersonmooptehboutofnetfamilypergroupmooptehbcombinnoonindividualmooptehbcombinnoonfamilyperpersonmooptehbcombinnoonfamilypergroupmoopmehbdedinntier1individualmehbdedinntier1familyperpersonmehbdedinntier1familypergroupmehbdedinntier1coinsurancemehbdedinntier2individualmehbdedinntier2familyperpersonmehbdedinntier2familypergroupmehbdedinntier2coinsurancemehbdedoutofnetindividualmehbdedoutofnetfamilyperpersonmehbdedoutofnetfamilypergroupmehbdedcombinnoonindividualmehbdedcombinnoonfamilyperpersonmehbdedcombinnoonfamilypergroupdehbdedinntier1individualdehbdedinntier1familyperpersondehbdedinntier1familypergroupdehbdedinntier1coinsurancedehbdedinntier2individualdehbdedinntier2familyperpersondehbdedinntier2familypergroupdehbdedinntier2coinsurancedehbdedoutofnetindividualdehbdedoutofnetfamilyperpersondehbdedoutofnetfamilypergroupdehbdedcombinnoonindividualdehbdedcombinnoonfamilyperpersondehbdedcombinnoonfamilypergrouptehbdedinntier1individualtehbdedinntier1familyperpersontehbdedinntier1familypergrouptehbdedinntier1coinsurancetehbdedinntier2individualtehbdedinntier2familyperpersontehbdedinntier2familypergrouptehbdedinntier2coinsurancetehbdedoutofnetindividualtehbdedoutofnetfamilyperpersontehbdedoutofnetfamilypergrouptehbdedcombinnoonindividualtehbdedcombinnoonfamilyperpersontehbdedcombinnoonfamilypergroupishsaeligiblehsaorhraemployercontributionhsaorhraemployercontributionamounturlforsummaryofbenefitscoverageplanbrochure
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0110001Delta Dental Premier Radiant Smiles Plan21989AK011AKN001AKS001ExistingIndemnityHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0110001-00Delta Dental Premier Radiant Smiles PlanStandard High Off Exchange Plan85.54No100000Not Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2018_AK.pdf
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0140001Delta Dental Premier, Voluntary, 1000, 100*/80/50, 5021989AK014AKN001AKS001ExistingIndemnityHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0140001-00Delta Dental Premier, Voluntary, 1000, 100*/80/50, 50Standard High Off Exchange Plan85.54No100000Not Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_100_SG_2018_AK.pdf
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0140002Delta Dental Premier, Voluntary, 1500, 100*/80/50, 5021989AK014AKN001AKS001ExistingIndemnityHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0140002-00Delta Dental Premier, Voluntary, 1500, 100*/80/50, 50Standard High Off Exchange Plan85.54No100000Not Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_100_SG_2018_AK.pdf
2018AK74819HIOS08/08/2017 02:20:00 AMSHOP (Small Group)Yes95-604239074819AK0010008BESTDental Standard - H74819AK001AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0010008-01BESTDental Standard - HStandard High On Exchange Plan87No100000$350 $350 per person$700 per group$700 $700 per person$1400 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per personper group not applicable
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0150001Delta Dental Premier, Voluntary, 1000, 80*/80/50, 5021989AK015AKN001AKS001ExistingIndemnityHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0150001-00Delta Dental Premier, Voluntary, 1000, 80*/80/50, 50Standard High Off Exchange Plan85.54No100000Not Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_80_SG_2018_AK.pdf
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0150002Delta Dental Premier, Voluntary, 1500, 80*/80/50, 5021989AK015AKN001AKS001ExistingIndemnityHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0150002-00Delta Dental Premier, Voluntary, 1500, 80*/80/50, 50Standard High Off Exchange Plan85.54No100000Not Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_80_SG_2018_AK.pdf
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0160001Delta Dental PPO, Voluntary, 1000, 100*/90/50, 5021989AK016AKN002AKS002ExistingPPOHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0160001-00Delta Dental PPO, Voluntary, 1000, 100*/90/50, 50Standard High Off Exchange Plan85.86No100000$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1000_100_SG_2018_AK.pdf
2018AK21989HIOS09/26/2017 02:21:00 AMSHOP (Small Group)Yes93-043877221989AK0160002Delta Dental PPO, Voluntary, 1500, 100*/90/50, 5021989AK016AKN002AKS002ExistingPPOHighNot ApplicableOff the ExchangeNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AMYesProviders treated as out-of-networkYesNational NetworkYes21989AK0160002-00Delta Dental PPO, Voluntary, 1500, 100*/90/50, 50Standard High Off Exchange Plan85.86No100000$350 $350 per person$700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per person$150 per grouphttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1500_100_SG_2018_AK.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540003Premera Blue Cross Preferred Plus Gold 150038344AK054AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M4/38344AK0540003-00Premera Blue Cross Preferred Plus Gold 1500Standard Gold Off Exchange Plan0.762817066YesYesNo1001500.0090.003300.0060.00200.002300.000.0020.001500.00200.0040.000.000206000.00$6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group30$3,000 $3000 per personper group not applicableNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042161_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540003Premera Blue Cross Preferred Plus Gold 150038344AK054AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M4/38344AK0540003-01Premera Blue Cross Preferred Plus Gold 1500Standard Gold On Exchange Plan0.762817066YesYesNo1001500.0090.003300.0060.00200.002300.000.0020.001500.00200.0040.000.000206000.00$6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group30$3,000 $3000 per personper group not applicableNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042162_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK74819HIOS08/08/2017 02:20:00 AMSHOP (Small Group)Yes95-604239074819AK0010010BESTDental Choice - H74819AK001AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0010010-00BESTDental Choice - HStandard High Off Exchange Plan87No100000$350 $350 per person$700 per group$700 $700 per person$1400 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per personper group not applicable
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540003Premera Blue Cross Preferred Plus Gold 150038344AK054AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M4/38344AK0540003-02Premera Blue Cross Preferred Plus Gold 1500Zero Cost Sharing Plan Variation1YesYesNo1000.000.000.0060.000.000.000.0020.000.000.000.000.000000.00$0 per person$0 per group$0 $0 per person$0 per group$0 $0 per person$0 per group0.00$0 per person$0 per group0$0 $0 per person$0 per group$0 $0 per person$0 per groupNohttps://www.premera.com/documents/042163_2018.pdfhttps://www.premera.com/documents/031040_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540003Premera Blue Cross Preferred Plus Gold 150038344AK054AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M4/38344AK0540003-03Premera Blue Cross Preferred Plus Gold 1500Limited Cost Sharing Plan Variation0.762817066YesYesNo1001500.0090.003300.0060.00200.002300.000.0020.001500.00200.0040.000.000206000.00$6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group30$3,000 $3000 per personper group not applicableNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042164_2018.pdfhttps://www.premera.com/documents/031040_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540006Premera Blue Cross Preferred Plus Silver 450038344AK054AKN001AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M4/38344AK0540006-00Premera Blue Cross Preferred Plus Silver 4500Standard Silver Off Exchange Plan0.686107015YesYesNo1004500.00100.002400.0060.00200.002700.000.0020.001600.00200.000.000.000207350.00$7350 per person$14700 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable4500.00$4500 per person$9000 per group30$9,000 $9000 per personper group not applicableNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042165_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540010Premera Blue Cross Preferred Plus Silver 3000 HSA38344AK054AKN001AKS001AKF003NewPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M2/38344AK0540010-01Premera Blue Cross Preferred Plus Silver 3000 HSAStandard Silver On Exchange Plan0.660349268YesYesNo1003000.000.002900.0060.003000.000.001300.0020.001900.000.000.000.000006600.00$6600 per person$13200 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable3000.00$3000 per person$6000 per group30$6,000 $6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableYeshttps://www.premera.com/documents/042181_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540010Premera Blue Cross Preferred Plus Silver 3000 HSA38344AK054AKN001AKS001AKF003NewPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M2/38344AK0540010-02Premera Blue Cross Preferred Plus Silver 3000 HSAZero Cost Sharing Plan Variation1YesYesNo1000.000.000.0060.000.000.000.0020.000.000.000.000.000000.00$0 per person$0 per group$0 $0 per person$0 per group$0 $0 per person$0 per group0.00$0 per person$0 per group0$0 $0 per person$0 per group$0 $0 per person$0 per groupNohttps://www.premera.com/documents/042182_2018.pdfhttps://www.premera.com/documents/031040_2018.pdf
2018AK74819HIOS08/08/2017 02:20:00 AMSHOP (Small Group)Yes95-604239074819AK0010010BESTDental Choice - H74819AK001AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0010010-01BESTDental Choice - HStandard High On Exchange Plan87No100000$350 $350 per person$700 per group$700 $700 per person$1400 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable$50 $50 per personper group not applicable
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540010Premera Blue Cross Preferred Plus Silver 3000 HSA38344AK054AKN001AKS001AKF003NewPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M2/38344AK0540010-03Premera Blue Cross Preferred Plus Silver 3000 HSALimited Cost Sharing Plan Variation0.660349268YesYesNo1003000.000.002900.0060.003000.000.001300.0020.001900.000.000.000.000006600.00$6600 per person$13200 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable3000.00$3000 per person$6000 per group30$6,000 $6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableYeshttps://www.premera.com/documents/042183_2018.pdfhttps://www.premera.com/documents/031040_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540010Premera Blue Cross Preferred Plus Silver 3000 HSA38344AK054AKN001AKS001AKF003NewPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M2/38344AK0540010-04Premera Blue Cross Preferred Plus Silver 3000 HSA73% AV Level Silver Plan0.720265739YesYesNo1002700.000.001100.0060.002700.000.001100.0020.001900.000.000.000.000003800.00$3800 per person$7600 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable2700.00$2700 per person$5400 per group30$5,200 $5200 per person$10400 per groupNot Applicableper person not applicableper group not applicableYeshttps://www.premera.com/documents/042184_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK38344HIOS11/01/2017 02:20:00 AMIndividualNo91-049924738344AK0540010Premera Blue Cross Preferred Plus Silver 3000 HSA38344AK054AKN001AKS001AKF003NewPPOSilverNot ApplicableNoBothNoNo0.00NoAllows Adult and Child-OnlyNoAsthma, Heart Disease, Diabetes0.99801/01/2018 12:00:00 AMYesBenefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.YesIf you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.Yeshttps://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspxhttps://www.premera.com/ak/visitor/pharmacy/drug-search/M2/38344AK0540010-05Premera Blue Cross Preferred Plus Silver 3000 HSA87% AV Level Silver Plan0.862239737YesYesNo100750.000.00700.0060.00750.000.00700.0020.00750.000.00400.000.000001400.00$1400 per person$2800 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable750.00$750 per person$1500 per group30$1,500 $1500 per person$3000 per groupNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042185_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
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