2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0110001 | Delta Dental Premier Radiant Smiles Plan | 21989AK011 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0110001-00 | Delta Dental Premier Radiant Smiles Plan | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierRadiantSmilesPlan_SG_2018_AK.pdf |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0140001 | Delta Dental Premier, Voluntary, 1000, 100*/80/50, 50 | 21989AK014 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0140001-00 | Delta Dental Premier, Voluntary, 1000, 100*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_100_SG_2018_AK.pdf |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0140002 | Delta Dental Premier, Voluntary, 1500, 100*/80/50, 50 | 21989AK014 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0140002-00 | Delta Dental Premier, Voluntary, 1500, 100*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_100_SG_2018_AK.pdf |
2018 | AK | 74819 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 74819AK0010008 | BESTDental Standard - H | 74819AK001 | | AKN001 | AKS001 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | No | | Yes | Full | Yes | http://www.bestlife.com/exchange/payment_option.html | | 74819AK0010008-01 | BESTDental Standard - H | Standard High On Exchange Plan | 87 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | $700 | $700 per person | $1400 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0150001 | Delta Dental Premier, Voluntary, 1000, 80*/80/50, 50 | 21989AK015 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0150001-00 | Delta Dental Premier, Voluntary, 1000, 80*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1000_80_SG_2018_AK.pdf |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0150002 | Delta Dental Premier, Voluntary, 1500, 80*/80/50, 50 | 21989AK015 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0150002-00 | Delta Dental Premier, Voluntary, 1500, 80*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremierVoluntary1500_80_SG_2018_AK.pdf |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0160001 | Delta Dental PPO, Voluntary, 1000, 100*/90/50, 50 | 21989AK016 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0160001-00 | Delta Dental PPO, Voluntary, 1000, 100*/90/50, 50 | Standard High Off Exchange Plan | 85.86 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1000_100_SG_2018_AK.pdf |
2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0160002 | Delta Dental PPO, Voluntary, 1500, 100*/90/50, 50 | 21989AK016 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0160002-00 | Delta Dental PPO, Voluntary, 1500, 100*/90/50, 50 | Standard High Off Exchange Plan | 85.86 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPOVoluntary1500_100_SG_2018_AK.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540003 | Premera Blue Cross Preferred Plus Gold 1500 | 38344AK054 | | AKN001 | AKS001 | AKF001 | Existing | PPO | Gold | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/ | 38344AK0540003-00 | Premera Blue Cross Preferred Plus Gold 1500 | Standard Gold Off Exchange Plan | | 0.762817066 | Yes | Yes | No | 100 | | 1500.00 | 90.00 | 3300.00 | 60.00 | 200.00 | 2300.00 | 0.00 | 20.00 | 1500.00 | 200.00 | 40.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6000.00 | $6000 per person | $12000 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 1500.00 | $1500 per person | $3000 per group | 30 | | | | | $3,000 | $3000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042161_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540003 | Premera Blue Cross Preferred Plus Gold 1500 | 38344AK054 | | AKN001 | AKS001 | AKF001 | Existing | PPO | Gold | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/ | 38344AK0540003-01 | Premera Blue Cross Preferred Plus Gold 1500 | Standard Gold On Exchange Plan | | 0.762817066 | Yes | Yes | No | 100 | | 1500.00 | 90.00 | 3300.00 | 60.00 | 200.00 | 2300.00 | 0.00 | 20.00 | 1500.00 | 200.00 | 40.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6000.00 | $6000 per person | $12000 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 1500.00 | $1500 per person | $3000 per group | 30 | | | | | $3,000 | $3000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042162_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
2018 | AK | 74819 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 74819AK0010010 | BESTDental Choice - H | 74819AK001 | | AKN001 | AKS001 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | No | | Yes | Full | Yes | http://www.bestlife.com/exchange/payment_option.html | | 74819AK0010010-00 | BESTDental Choice - H | Standard High Off Exchange Plan | 87 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | $700 | $700 per person | $1400 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540003 | Premera Blue Cross Preferred Plus Gold 1500 | 38344AK054 | | AKN001 | AKS001 | AKF001 | Existing | PPO | Gold | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/ | 38344AK0540003-02 | Premera Blue Cross Preferred Plus Gold 1500 | Zero Cost Sharing Plan Variation | | 1 | Yes | Yes | No | 100 | | 0.00 | 0.00 | 0.00 | 60.00 | 0.00 | 0.00 | 0.00 | 20.00 | 0.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 0.00 | $0 per person | $0 per group | | | | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 0.00 | $0 per person | $0 per group | 0 | | | | | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | No | | | https://www.premera.com/documents/042163_2018.pdf | https://www.premera.com/documents/031040_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540003 | Premera Blue Cross Preferred Plus Gold 1500 | 38344AK054 | | AKN001 | AKS001 | AKF001 | Existing | PPO | Gold | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/ | 38344AK0540003-03 | Premera Blue Cross Preferred Plus Gold 1500 | Limited Cost Sharing Plan Variation | | 0.762817066 | Yes | Yes | No | 100 | | 1500.00 | 90.00 | 3300.00 | 60.00 | 200.00 | 2300.00 | 0.00 | 20.00 | 1500.00 | 200.00 | 40.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6000.00 | $6000 per person | $12000 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 1500.00 | $1500 per person | $3000 per group | 30 | | | | | $3,000 | $3000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042164_2018.pdf | https://www.premera.com/documents/031040_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540006 | Premera Blue Cross Preferred Plus Silver 4500 | 38344AK054 | | AKN001 | AKS001 | AKF002 | Existing | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M4/ | 38344AK0540006-00 | Premera Blue Cross Preferred Plus Silver 4500 | Standard Silver Off Exchange Plan | | 0.686107015 | Yes | Yes | No | 100 | | 4500.00 | 100.00 | 2400.00 | 60.00 | 200.00 | 2700.00 | 0.00 | 20.00 | 1600.00 | 200.00 | 0.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 4500.00 | $4500 per person | $9000 per group | 30 | | | | | $9,000 | $9000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042165_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540010 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/ | 38344AK0540010-01 | Premera Blue Cross Preferred Plus Silver 3000 HSA | Standard Silver On Exchange Plan | | 0.660349268 | Yes | Yes | No | 100 | | 3000.00 | 0.00 | 2900.00 | 60.00 | 3000.00 | 0.00 | 1300.00 | 20.00 | 1900.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6600.00 | $6600 per person | $13200 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 3000.00 | $3000 per person | $6000 per group | 30 | | | | | $6,000 | $6000 per person | $12000 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042181_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540010 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/ | 38344AK0540010-02 | Premera Blue Cross Preferred Plus Silver 3000 HSA | Zero Cost Sharing Plan Variation | | 1 | Yes | Yes | No | 100 | | 0.00 | 0.00 | 0.00 | 60.00 | 0.00 | 0.00 | 0.00 | 20.00 | 0.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 0.00 | $0 per person | $0 per group | | | | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 0.00 | $0 per person | $0 per group | 0 | | | | | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | No | | | https://www.premera.com/documents/042182_2018.pdf | https://www.premera.com/documents/031040_2018.pdf |
2018 | AK | 74819 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 74819AK0010010 | BESTDental Choice - H | 74819AK001 | | AKN001 | AKS001 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | No | | Yes | Full | Yes | http://www.bestlife.com/exchange/payment_option.html | | 74819AK0010010-01 | BESTDental Choice - H | Standard High On Exchange Plan | 87 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | $700 | $700 per person | $1400 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540010 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/ | 38344AK0540010-03 | Premera Blue Cross Preferred Plus Silver 3000 HSA | Limited Cost Sharing Plan Variation | | 0.660349268 | Yes | Yes | No | 100 | | 3000.00 | 0.00 | 2900.00 | 60.00 | 3000.00 | 0.00 | 1300.00 | 20.00 | 1900.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6600.00 | $6600 per person | $13200 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 3000.00 | $3000 per person | $6000 per group | 30 | | | | | $6,000 | $6000 per person | $12000 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042183_2018.pdf | https://www.premera.com/documents/031040_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540010 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/ | 38344AK0540010-04 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 73% AV Level Silver Plan | | 0.720265739 | Yes | Yes | No | 100 | | 2700.00 | 0.00 | 1100.00 | 60.00 | 2700.00 | 0.00 | 1100.00 | 20.00 | 1900.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 3800.00 | $3800 per person | $7600 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 2700.00 | $2700 per person | $5400 per group | 30 | | | | | $5,200 | $5200 per person | $10400 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042184_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540010 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Silver | Not Applicable | No | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Diabetes | 0.998 | | | 01/01/2018 12:00:00 AM | | Yes | Benefits 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. | Yes | If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service. | Yes | https://premera.softheon.com/Marketplace.AK/PaymentCenter/Payment.aspx | https://www.premera.com/ak/visitor/pharmacy/drug-search/M2/ | 38344AK0540010-05 | Premera Blue Cross Preferred Plus Silver 3000 HSA | 87% AV Level Silver Plan | | 0.862239737 | Yes | Yes | No | 100 | | 750.00 | 0.00 | 700.00 | 60.00 | 750.00 | 0.00 | 700.00 | 20.00 | 750.00 | 0.00 | 400.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 1400.00 | $1400 per person | $2800 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 750.00 | $750 per person | $1500 per group | 30 | | | | | $1,500 | $1500 per person | $3000 per group | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042185_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |