| 2018 | AK | 73836 | HIOS | 09/02/2017 02:21:00 AM | SHOP (Small Group) | No | 93-0989307 | 73836AK0810002 | Endeavor Providence Bronze 7350 | 73836AK081 | | AKN002 | AKS001 | AKF004 | Existing | PPO | Bronze | Not Applicable | No | Both | No | No | | | | Yes | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs | | | | 01/01/2018 12:00:00 AM | | No | | Yes | Travel Network | No | | http://www.modahealth.com/pdl?type=SG&state=AK | 73836AK0810002-00 | Endeavor Providence Bronze 7350 | Standard Bronze Off Exchange Plan | | 0.605988703 | Yes | Yes | No | 100 | | 7350.00 | 0.00 | 0.00 | 300.00 | 5310.00 | 800.00 | 0.00 | 60.00 | 1460.00 | 400.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | | | | $22,050 | $22050 per person | $44100 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | 0 | | | | | $22,050 | $22050 per person | $44100 per group | Not Applicable | per person not applicable | per group not applicable | No | No | | https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf |
| 2018 | AK | 73836 | HIOS | 09/02/2017 02:21:00 AM | SHOP (Small Group) | No | 93-0989307 | 73836AK0810002 | Endeavor Providence Bronze 7350 | 73836AK081 | | AKN002 | AKS001 | AKF004 | Existing | PPO | Bronze | Not Applicable | No | Both | No | No | | | | Yes | Allows Adult and Child-Only | | No | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs | | | | 01/01/2018 12:00:00 AM | | No | | Yes | Travel Network | No | | http://www.modahealth.com/pdl?type=SG&state=AK | 73836AK0810002-01 | Endeavor Providence Bronze 7350 | Standard Bronze On Exchange Plan | | 0.605988703 | Yes | Yes | No | 100 | | 7350.00 | 0.00 | 0.00 | 300.00 | 5310.00 | 800.00 | 0.00 | 60.00 | 1460.00 | 400.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | | | | $22,050 | $22050 per person | $44100 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | 0 | | | | | $22,050 | $22050 per person | $44100 per group | Not Applicable | per person not applicable | per group not applicable | No | No | | https://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze7350_SBC_SG_2018_AK.pdf | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze7350_SG_2018_AK.pdf |
| 2018 | AK | 74819 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 74819AK0010009 | BESTDental Standard - L | 74819AK001 | | AKN001 | AKS001 | | Existing | PPO | Low | 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 | | 74819AK0010009-00 | BESTDental Standard - L | Standard Low Off Exchange Plan | 70.8 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $75 | $75 per person | per group not applicable | | | | | | $100 | $100 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 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/ | 38344AK0540006-01 | Premera Blue Cross Preferred Plus Silver 4500 | Standard Silver On 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/042166_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 | 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/ | 38344AK0540006-02 | Premera Blue Cross Preferred Plus Silver 4500 | 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/042167_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/ | 38344AK0540006-03 | Premera Blue Cross Preferred Plus Silver 4500 | Limited Cost Sharing Plan Variation | | 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/042168_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/ | 38344AK0540006-04 | Premera Blue Cross Preferred Plus Silver 4500 CSR1 | 73% AV Level Silver Plan | | 0.720567785 | Yes | Yes | No | 100 | | 4000.00 | 0.00 | 1900.00 | 60.00 | 200.00 | 2600.00 | 0.00 | 20.00 | 1600.00 | 200.00 | 0.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 5850.00 | $5850 per person | $11700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 4000.00 | $4000 per person | $8000 per group | 30 | | | | | $8,000 | $8000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042169_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 | 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/ | 38344AK0540006-05 | Premera Blue Cross Preferred Plus Silver 4500 CSR2 | 87% AV Level Silver Plan | | 0.861036387 | Yes | Yes | No | 100 | | 1000.00 | 0.00 | 900.00 | 60.00 | 200.00 | 1700.00 | 0.00 | 20.00 | 1000.00 | 90.00 | 200.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 1850.00 | $1850 per person | $3700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 1000.00 | $1000 per person | $2000 per group | 30 | | | | | $2,000 | $2000 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042170_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
| 2018 | AK | 74819 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 74819AK0020005 | BESTOne Plus Silver | 74819AK002 | | AKN001 | AKS001 | | Existing | PPO | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | 12/31/2018 12:00:00 AM | No | | Yes | Full | Yes | http://www.bestlife.com/exchange/payment_option.html | | 74819AK0020005-01 | BESTOne Plus Silver | Standard Low On Exchange Plan | 70.8 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $75 | $75 per person | per group not applicable | | | | | | $100 | $100 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.bestlife.com/ak/current/AK_BESTOne_Dental_Plus-Silver_Plan.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/ | 38344AK0540006-06 | Premera Blue Cross Preferred Plus Silver 4500 CSR3 | 94% AV Level Silver Plan | | 0.932445335 | Yes | Yes | No | 100 | | 300.00 | 0.00 | 400.00 | 60.00 | 100.00 | 600.00 | 0.00 | 20.00 | 300.00 | 0.00 | 400.00 | 0.00 | | 0 | 2 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 700.00 | $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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 300.00 | $300 per person | $600 per group | 30 | | | | | $600 | $600 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042171_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 | 38344AK0540008 | Premera Blue Cross Preferred Plus Bronze 6350 | 38344AK054 | | AKN001 | AKS001 | AKF003 | Existing | PPO | Bronze | 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/ | 38344AK0540008-00 | Premera Blue Cross Preferred Plus Bronze 6350 | Standard Bronze Off Exchange Plan | | 0.615065145 | Yes | Yes | No | 100 | | 6350.00 | 0.00 | 1000.00 | 60.00 | 200.00 | 400.00 | 1800.00 | 20.00 | 1600.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 6350.00 | $6350 per person | $12700 per group | 30 | | | | | $12,700 | $12700 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042172_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 | 38344AK0540008 | Premera Blue Cross Preferred Plus Bronze 6350 | 38344AK054 | | AKN001 | AKS001 | AKF003 | Existing | PPO | Bronze | 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/ | 38344AK0540008-01 | Premera Blue Cross Preferred Plus Bronze 6350 | Standard Bronze On Exchange Plan | | 0.615065145 | Yes | Yes | No | 100 | | 6350.00 | 0.00 | 1000.00 | 60.00 | 200.00 | 400.00 | 1800.00 | 20.00 | 1600.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 6350.00 | $6350 per person | $12700 per group | 30 | | | | | $12,700 | $12700 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042173_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 | 38344AK0540008 | Premera Blue Cross Preferred Plus Bronze 6350 | 38344AK054 | | AKN001 | AKS001 | AKF003 | Existing | PPO | Bronze | 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/ | 38344AK0540008-02 | Premera Blue Cross Preferred Plus Bronze 6350 | 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/042174_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 | 38344AK0540008 | Premera Blue Cross Preferred Plus Bronze 6350 | 38344AK054 | | AKN001 | AKS001 | AKF003 | Existing | PPO | Bronze | 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/ | 38344AK0540008-03 | Premera Blue Cross Preferred Plus Bronze 6350 | Limited Cost Sharing Plan Variation | | 0.615065145 | Yes | Yes | No | 100 | | 6350.00 | 0.00 | 1000.00 | 60.00 | 200.00 | 400.00 | 1800.00 | 20.00 | 1600.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 6350.00 | $6350 per person | $12700 per group | 30 | | | | | $12,700 | $12700 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | No | | | https://www.premera.com/documents/042175_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 | 74819AK0010009 | BESTDental Standard - L | 74819AK001 | | AKN001 | AKS001 | | Existing | PPO | Low | 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 | | 74819AK0010009-01 | BESTDental Standard - L | Standard Low On Exchange Plan | 70.8 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $75 | $75 per person | per group not applicable | | | | | | $100 | $100 per person | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| 2018 | AK | 38344 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 91-0499247 | 38344AK0540009 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Bronze | 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/ | 38344AK0540009-00 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | Standard Bronze Off Exchange Plan | | 0.611095907 | Yes | Yes | No | 100 | | 5250.00 | 0.00 | 1400.00 | 60.00 | 5250.00 | 0.00 | 600.00 | 20.00 | 1600.00 | 0.00 | 90.00 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 5250.00 | $5250 per person | $10500 per group | 30 | | | | | $10,500 | $10500 per person | $21000 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042176_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 | 38344AK0540009 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Bronze | 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/ | 38344AK0540009-01 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | Standard Bronze On Exchange Plan | | 0.611095907 | Yes | Yes | No | 100 | | 5250.00 | 0.00 | 1400.00 | 60.00 | 5250.00 | 0.00 | 600.00 | 20.00 | 1600.00 | 0.00 | 90.00 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 5250.00 | $5250 per person | $10500 per group | 30 | | | | | $10,500 | $10500 per person | $21000 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042177_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 | 38344AK0540009 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Bronze | 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/ | 38344AK0540009-02 | Premera Blue Cross Preferred Plus Bronze 5250 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/042178_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 | 38344AK0540009 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | 38344AK054 | | AKN001 | AKS001 | AKF003 | New | PPO | Bronze | 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/ | 38344AK0540009-03 | Premera Blue Cross Preferred Plus Bronze 5250 HSA | Limited Cost Sharing Plan Variation | | 0.611095907 | Yes | Yes | No | 100 | | 5250.00 | 0.00 | 1400.00 | 60.00 | 5250.00 | 0.00 | 600.00 | 20.00 | 1600.00 | 0.00 | 90.00 | 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 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 5250.00 | $5250 per person | $10500 per group | 30 | | | | | $10,500 | $10500 per person | $21000 per group | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://www.premera.com/documents/042179_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/ | 38344AK0540010-00 | Premera Blue Cross Preferred Plus Silver 3000 HSA | Standard Silver Off 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/042180_2018.pdf | https://www.premera.com/documents/007528_2018.pdf |
