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Healthcare.gov Dataset Explorer

Healthcare.gov Dataset Explorer

Dataset: 9epp-mpe8

businessyearstatecodeissueridsourcenameimportdatemarketcoveragedentalonlyplantinstandardcomponentidplanmarketingnamehiosproductidhpidnetworkidserviceareaidformularyidisnewplanplantypemetalleveldesigntypeuniqueplandesignqhpnonqhptypeidisnoticerequiredforpregnancyisreferralrequiredforspecialistspecialistrequiringreferralplanlevelexclusionsindianplanvariationestimatedadvancedpaymentamountperenrolleecompositeratingofferedchildonlyofferingchildonlyplanidwellnessprogramoffereddiseasemanagementprogramsofferedehbpercenttotalpremiumehbpediatricdentalapportionmentquantityisguaranteedrateplaneffectivedateplanexpirationdateoutofcountrycoverageoutofcountrycoveragedescriptionoutofserviceareacoverageoutofserviceareacoveragedescriptionnationalnetworkurlforenrollmentpaymentformularyurlplanidplanvariantmarketingnamecsrvariationtypeissueractuarialvalueavcalculatoroutputnumbermedicaldrugdeductiblesintegratedmedicaldrugmaximumoutofpocketintegratedmultipleinnetworktiersfirsttierutilizationsecondtierutilizationsbchavingababydeductiblesbchavingababycopaymentsbchavingababycoinsurancesbchavingababylimitsbchavingdiabetesdeductiblesbchavingdiabetescopaymentsbchavingdiabetescoinsurancesbchavingdiabeteslimitsbchavingsimplefracturedeductiblesbchavingsimplefracturecopaymentsbchavingsimplefracturecoinsurancesbchavingsimplefracturelimitspecialtydrugmaximumcoinsuranceinpatientcopaymentmaximumdaysbeginprimarycarecostsharingafternumberofvisitsbeginprimarycaredeductiblecoinsuranceafternumberofcopaysmehbinntier1individualmoopmehbinntier1familyperpersonmoopmehbinntier1familypergroupmoopmehbinntier2individualmoopmehbinntier2familyperpersonmoopmehbinntier2familypergroupmoopmehboutofnetindividualmoopmehboutofnetfamilyperpersonmoopmehboutofnetfamilypergroupmoopmehbcombinnoonindividualmoopmehbcombinnoonfamilyperpersonmoopmehbcombinnoonfamilypergroupmoopdehbinntier1individualmoopdehbinntier1familyperpersonmoopdehbinntier1familypergroupmoopdehbinntier2individualmoopdehbinntier2familyperpersonmoopdehbinntier2familypergroupmoopdehboutofnetindividualmoopdehboutofnetfamilyperpersonmoopdehboutofnetfamilypergroupmoopdehbcombinnoonindividualmoopdehbcombinnoonfamilyperpersonmoopdehbcombinnoonfamilypergroupmooptehbinntier1individualmooptehbinntier1familyperpersonmooptehbinntier1familypergroupmooptehbinntier2individualmooptehbinntier2familyperpersonmooptehbinntier2familypergroupmooptehboutofnetindividualmooptehboutofnetfamilyperpersonmooptehboutofnetfamilypergroupmooptehbcombinnoonindividualmooptehbcombinnoonfamilyperpersonmooptehbcombinnoonfamilypergroupmoopmehbdedinntier1individualmehbdedinntier1familyperpersonmehbdedinntier1familypergroupmehbdedinntier1coinsurancemehbdedinntier2individualmehbdedinntier2familyperpersonmehbdedinntier2familypergroupmehbdedinntier2coinsurancemehbdedoutofnetindividualmehbdedoutofnetfamilyperpersonmehbdedoutofnetfamilypergroupmehbdedcombinnoonindividualmehbdedcombinnoonfamilyperpersonmehbdedcombinnoonfamilypergroupdehbdedinntier1individualdehbdedinntier1familyperpersondehbdedinntier1familypergroupdehbdedinntier1coinsurancedehbdedinntier2individualdehbdedinntier2familyperpersondehbdedinntier2familypergroupdehbdedinntier2coinsurancedehbdedoutofnetindividualdehbdedoutofnetfamilyperpersondehbdedoutofnetfamilypergroupdehbdedcombinnoonindividualdehbdedcombinnoonfamilyperpersondehbdedcombinnoonfamilypergrouptehbdedinntier1individualtehbdedinntier1familyperpersontehbdedinntier1familypergrouptehbdedinntier1coinsurancetehbdedinntier2individualtehbdedinntier2familyperpersontehbdedinntier2familypergrouptehbdedinntier2coinsurancetehbdedoutofnetindividualtehbdedoutofnetfamilyperpersontehbdedoutofnetfamilypergrouptehbdedcombinnoonindividualtehbdedcombinnoonfamilyperpersontehbdedcombinnoonfamilypergroupishsaeligiblehsaorhraemployercontributionhsaorhraemployercontributionamounturlforsummaryofbenefitscoverageplanbrochure
2018AK74819HIOS08/08/2017 02:20:00 AMSHOP (Small Group)Yes95-604239074819AK0010011BESTDental Choice - L74819AK001AKN001AKS001ExistingPPOLowNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0010011-00BESTDental Choice - LStandard Low Off Exchange Plan70.8No100000$350 $350 per person$700 per group$700 $700 per person$1400 per groupNot Applicableper person not applicableper group not applicable$75 $75 per personper group not applicable$100 $100 per personper group not applicableNot Applicableper person not applicableper 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/M2/38344AK0540010-06Premera Blue Cross Preferred Plus Silver 3000 HSA94% AV Level Silver Plan0.94159631YesYesNo100250.000.00300.0060.00250.000.00300.0020.00250.000.00300.000.00000500.00$500 per person$1000 per groupNot Applicableper person not applicableper group not applicableNot Applicableper person not applicableper group not applicable250.00$250 per person$500 per group30$500 $500 per person$1000 per groupNot Applicableper person not applicableper group not applicableNohttps://www.premera.com/documents/042186_2018.pdfhttps://www.premera.com/documents/007528_2018.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700001Endeavor Providence Gold 50073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700001-00Endeavor Providence Gold 500Standard Gold Off Exchange Plan0.813083276YesYesNo100500.0040.002400.00300.00500.001100.00300.0060.00500.00400.00200.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable500.00$500 per person$1000 per group20$1,500 $1500 per person$3000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700001Endeavor Providence Gold 50073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700001-01Endeavor Providence Gold 500Standard Gold On Exchange Plan0.813083276YesYesNo100500.0040.002400.00300.00500.001100.00300.0060.00500.00400.00200.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable500.00$500 per person$1000 per group20$1,500 $1500 per person$3000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700002Endeavor Providence Gold 100073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700002-00Endeavor Providence Gold 1000Standard Gold Off Exchange Plan0.802456118YesYesNo1001000.0040.002300.00300.001000.001100.00200.0060.001000.00400.0050.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1000.00$1000 per person$2000 per group20$3,000 $3000 per person$6000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700002Endeavor Providence Gold 100073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700002-01Endeavor Providence Gold 1000Standard Gold On Exchange Plan0.802456118YesYesNo1001000.0040.002300.00300.001000.001100.00200.0060.001000.00400.0050.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1000.00$1000 per person$2000 per group20$3,000 $3000 per person$6000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700003Endeavor Providence Gold 150073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700003-00Endeavor Providence Gold 1500Standard Gold Off Exchange Plan0.794060591YesYesNo1001500.0040.002200.00300.001500.001100.0070.0060.001190.00400.0010.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group20$4,500 $4500 per person$9000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700003Endeavor Providence Gold 150073836AK070AKN002AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700003-01Endeavor Providence Gold 1500Standard Gold On Exchange Plan0.794060591YesYesNo1001500.0040.002200.00300.001500.001100.0070.0060.001190.00400.0010.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group20$4,500 $4500 per person$9000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Gold1500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Gold1500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700006Endeavor Select Gold 50073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700006-00Endeavor Select Gold 500Standard Gold Off Exchange Plan0.813083276YesYesNo100500.0040.002400.00300.00500.001100.00300.0060.00500.00400.00200.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable500.00$500 per person$1000 per group20$1,500 $1500 per person$3000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700006Endeavor Select Gold 50073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700006-01Endeavor Select Gold 500Standard Gold On Exchange Plan0.813083276YesYesNo100500.0040.002400.00300.00500.001100.00300.0060.00500.00400.00200.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable500.00$500 per person$1000 per group20$1,500 $1500 per person$3000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700007Endeavor Select Gold 100073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700007-00Endeavor Select Gold 1000Standard Gold Off Exchange Plan0.802456118YesYesNo1001000.0040.002300.00300.001000.001100.00200.0060.001000.00400.0050.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1000.00$1000 per person$2000 per group20$3,000 $3000 per person$6000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700007Endeavor Select Gold 100073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700007-01Endeavor Select Gold 1000Standard Gold On Exchange Plan0.802456118YesYesNo1001000.0040.002300.00300.001000.001100.00200.0060.001000.00400.0050.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1000.00$1000 per person$2000 per group20$3,000 $3000 per person$6000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700008Endeavor Select Gold 150073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700008-00Endeavor Select Gold 1500Standard Gold Off Exchange Plan0.794060591YesYesNo1001500.0040.002200.00300.001500.001100.0070.0060.001190.00400.0010.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group20$4,500 $4500 per person$9000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1500_SG_2018_AK.pdf
2018FL17121HIOS08/17/2017 02:20:00 AMIndividualYes95-604239017121FL0020006BEST Dental Basic - Silver17121FL002FLN001FLS001NewPPOLowNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AM12/31/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html17121FL0020006-01BEST Dental Basic - SilverStandard Low On Exchange Plan70No100000$350 $350 per person$700 per group$700 $700 per person$1400 per groupNot Applicableper person not applicableper group not applicable$75 $75 per personper group not applicable$100 $100 per personper group not applicableNot Applicableper person not applicableper group not applicable
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700008Endeavor Select Gold 150073836AK070AKN001AKS001AKF001ExistingPPOGoldNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700008-01Endeavor Select Gold 1500Standard Gold On Exchange Plan0.794060591YesYesNo1001500.0040.002200.00300.001500.001100.0070.0060.001190.00400.0010.000.000007000.00$7000 per person$14000 per group$21,000 $21000 per person$42000 per groupNot Applicableper person not applicableper group not applicable1500.00$1500 per person$3000 per group20$4,500 $4500 per person$9000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Gold1500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Gold1500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710002Endeavor Providence Silver 200073836AK071AKN002AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0710002-00Endeavor Providence Silver 2000Standard Silver Off Exchange Plan0.719996654YesYesNo1002000.0040.003600.00300.001730.001900.0050.0060.001460.00200.0020.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable2000.00$2000 per person$4000 per group35$6,000 $6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710002Endeavor Providence Silver 200073836AK071AKN002AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0710002-01Endeavor Providence Silver 2000Standard Silver On Exchange Plan0.719996654YesYesNo1002000.0040.003600.00300.001730.001900.0050.0060.001460.00200.0020.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable2000.00$2000 per person$4000 per group35$6,000 $6000 per person$12000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700004Endeavor Providence Silver 250073836AK070AKN002AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700004-00Endeavor Providence Silver 2500Standard Silver Off Exchange Plan0.714196731YesYesNo1002500.0040.003500.00300.001730.001900.0050.0060.001460.00200.0020.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable2500.00$2500 per person$5000 per group35$7,500 $7500 per person$15000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0700004Endeavor Providence Silver 250073836AK070AKN002AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0700004-01Endeavor Providence Silver 2500Standard Silver On Exchange Plan0.714196731YesYesNo1002500.0040.003500.00300.001730.001900.0050.0060.001460.00200.0020.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable2500.00$2500 per person$5000 per group35$7,500 $7500 per person$15000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710003Endeavor Providence Silver 300073836AK071AKN002AKS001AKF002ExistingPPOSilverNot ApplicableNoBothNoNoYesAllows Adult and Child-OnlyNoAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs01/01/2018 12:00:00 AMNoYesTravel NetworkNohttp://www.modahealth.com/pdl?type=SG&state=AK73836AK0710003-00Endeavor Providence Silver 3000Standard Silver Off Exchange Plan0.709104254YesYesNo1003000.0040.003300.00300.001730.001900.0050.0060.001460.00200.0020.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable3000.00$3000 per person$6000 per group35$9,000 $9000 per person$18000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver3000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver3000_SG_2018_AK.pdf
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