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Healthcare.gov Dataset Explorer

Healthcare.gov Dataset Explorer

Dataset: 9epp-mpe8

businessyearstatecodeissueridsourcenameimportdatemarketcoveragedentalonlyplantinstandardcomponentidplanmarketingnamehiosproductidhpidnetworkidserviceareaidformularyidisnewplanplantypemetalleveldesigntypeuniqueplandesignqhpnonqhptypeidisnoticerequiredforpregnancyisreferralrequiredforspecialistspecialistrequiringreferralplanlevelexclusionsindianplanvariationestimatedadvancedpaymentamountperenrolleecompositeratingofferedchildonlyofferingchildonlyplanidwellnessprogramoffereddiseasemanagementprogramsofferedehbpercenttotalpremiumehbpediatricdentalapportionmentquantityisguaranteedrateplaneffectivedateplanexpirationdateoutofcountrycoverageoutofcountrycoveragedescriptionoutofserviceareacoverageoutofserviceareacoveragedescriptionnationalnetworkurlforenrollmentpaymentformularyurlplanidplanvariantmarketingnamecsrvariationtypeissueractuarialvalueavcalculatoroutputnumbermedicaldrugdeductiblesintegratedmedicaldrugmaximumoutofpocketintegratedmultipleinnetworktiersfirsttierutilizationsecondtierutilizationsbchavingababydeductiblesbchavingababycopaymentsbchavingababycoinsurancesbchavingababylimitsbchavingdiabetesdeductiblesbchavingdiabetescopaymentsbchavingdiabetescoinsurancesbchavingdiabeteslimitsbchavingsimplefracturedeductiblesbchavingsimplefracturecopaymentsbchavingsimplefracturecoinsurancesbchavingsimplefracturelimitspecialtydrugmaximumcoinsuranceinpatientcopaymentmaximumdaysbeginprimarycarecostsharingafternumberofvisitsbeginprimarycaredeductiblecoinsuranceafternumberofcopaysmehbinntier1individualmoopmehbinntier1familyperpersonmoopmehbinntier1familypergroupmoopmehbinntier2individualmoopmehbinntier2familyperpersonmoopmehbinntier2familypergroupmoopmehboutofnetindividualmoopmehboutofnetfamilyperpersonmoopmehboutofnetfamilypergroupmoopmehbcombinnoonindividualmoopmehbcombinnoonfamilyperpersonmoopmehbcombinnoonfamilypergroupmoopdehbinntier1individualmoopdehbinntier1familyperpersonmoopdehbinntier1familypergroupmoopdehbinntier2individualmoopdehbinntier2familyperpersonmoopdehbinntier2familypergroupmoopdehboutofnetindividualmoopdehboutofnetfamilyperpersonmoopdehboutofnetfamilypergroupmoopdehbcombinnoonindividualmoopdehbcombinnoonfamilyperpersonmoopdehbcombinnoonfamilypergroupmooptehbinntier1individualmooptehbinntier1familyperpersonmooptehbinntier1familypergroupmooptehbinntier2individualmooptehbinntier2familyperpersonmooptehbinntier2familypergroupmooptehboutofnetindividualmooptehboutofnetfamilyperpersonmooptehboutofnetfamilypergroupmooptehbcombinnoonindividualmooptehbcombinnoonfamilyperpersonmooptehbcombinnoonfamilypergroupmoopmehbdedinntier1individualmehbdedinntier1familyperpersonmehbdedinntier1familypergroupmehbdedinntier1coinsurancemehbdedinntier2individualmehbdedinntier2familyperpersonmehbdedinntier2familypergroupmehbdedinntier2coinsurancemehbdedoutofnetindividualmehbdedoutofnetfamilyperpersonmehbdedoutofnetfamilypergroupmehbdedcombinnoonindividualmehbdedcombinnoonfamilyperpersonmehbdedcombinnoonfamilypergroupdehbdedinntier1individualdehbdedinntier1familyperpersondehbdedinntier1familypergroupdehbdedinntier1coinsurancedehbdedinntier2individualdehbdedinntier2familyperpersondehbdedinntier2familypergroupdehbdedinntier2coinsurancedehbdedoutofnetindividualdehbdedoutofnetfamilyperpersondehbdedoutofnetfamilypergroupdehbdedcombinnoonindividualdehbdedcombinnoonfamilyperpersondehbdedcombinnoonfamilypergrouptehbdedinntier1individualtehbdedinntier1familyperpersontehbdedinntier1familypergrouptehbdedinntier1coinsurancetehbdedinntier2individualtehbdedinntier2familyperpersontehbdedinntier2familypergrouptehbdedinntier2coinsurancetehbdedoutofnetindividualtehbdedoutofnetfamilyperpersontehbdedoutofnetfamilypergrouptehbdedcombinnoonindividualtehbdedcombinnoonfamilyperpersontehbdedcombinnoonfamilypergroupishsaeligiblehsaorhraemployercontributionhsaorhraemployercontributionamounturlforsummaryofbenefitscoverageplanbrochure
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0820004Endeavor Providence Bronze 500073836AK082AKN002AKS001AKF003ExistingPPOBronzeNot 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=AK73836AK0820004-01Endeavor Providence Bronze 5000Standard Bronze On Exchange Plan0.59409672YesYesNo1005000.000.002400.00300.005000.000.00900.0060.001930.000.000.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable5000.00$5000 per person$10000 per group50$15,000 $15000 per person$30000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880001Endeavor Select Silver HDHP 200073836AK088AKN001AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880001-00Endeavor Select Silver HDHP 2000Standard Silver Off Exchange Plan0.713552098YesYesNo1002000.000.002600.00300.002000.000.001500.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2000.00per person not applicable$4000 per group25$6,000 per person not applicable$12000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880001Endeavor Select Silver HDHP 200073836AK088AKN001AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880001-01Endeavor Select Silver HDHP 2000Standard Silver On Exchange Plan0.713552098YesYesNo1002000.000.002600.00300.002000.000.001500.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2000.00per person not applicable$4000 per group25$6,000 per person not applicable$12000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880002Endeavor Select Silver HDHP 250073836AK088AKN001AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880002-00Endeavor Select Silver HDHP 2500Standard Silver Off Exchange Plan0.697573394YesYesNo1002500.000.002500.00300.002500.000.001300.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2500.00per person not applicable$5000 per group25$7,500 per person not applicable$15000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880002Endeavor Select Silver HDHP 250073836AK088AKN001AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880002-01Endeavor Select Silver HDHP 2500Standard Silver On Exchange Plan0.697573394YesYesNo1002500.000.002500.00300.002500.000.001300.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2500.00per person not applicable$5000 per group25$7,500 per person not applicable$15000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Silver_HDHP_2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880003Endeavor Providence Silver HDHP 200073836AK088AKN002AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880003-00Endeavor Providence Silver HDHP 2000Standard Silver Off Exchange Plan0.713552098YesYesNo1002000.000.002600.00300.002000.000.001500.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2000.00per person not applicable$4000 per group25$6,000 per person not applicable$12000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880003Endeavor Providence Silver HDHP 200073836AK088AKN002AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880003-01Endeavor Providence Silver HDHP 2000Standard Silver On Exchange Plan0.713552098YesYesNo1002000.000.002600.00300.002000.000.001500.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2000.00per person not applicable$4000 per group25$6,000 per person not applicable$12000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2000_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880004Endeavor Providence Silver HDHP 250073836AK088AKN002AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880004-00Endeavor Providence Silver HDHP 2500Standard Silver Off Exchange Plan0.697573394YesYesNo1002500.000.002500.00300.002500.000.001300.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2500.00per person not applicable$5000 per group25$7,500 per person not applicable$15000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0880004Endeavor Providence Silver HDHP 250073836AK088AKN002AKS001AKF006ExistingPPOSilverNot 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=AK73836AK0880004-01Endeavor Providence Silver HDHP 2500Standard Silver On Exchange Plan0.697573394YesYesNo1002500.000.002500.00300.002500.000.001300.0060.001930.000.000.000.000005250.00$5250 per person$10500 per group$15,750 $15750 per person$31500 per groupNot Applicableper person not applicableper group not applicable2500.00per person not applicable$5000 per group25$7,500 per person not applicable$15000 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Silver_HDHP_2500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710017Endeavor Providence Bronze HDHP 330073836AK071AKN002AKS001AKF007NewPPOExpanded BronzeNot 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=AK73836AK0710017-00Endeavor Providence Bronze HDHP 3300Standard Bronze Off Exchange Plan0.62828673YesYesNo1003300.000.003300.00300.003300.000.001800.0060.001930.000.000.000.000006600.00$6600 per person$13200 per group$19,800 $19800 per person$39600 per groupNot Applicableper person not applicableper group not applicable3300.00per person not applicable$6600 per group50$9,900 per person not applicable$19800 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710017Endeavor Providence Bronze HDHP 330073836AK071AKN002AKS001AKF007NewPPOExpanded BronzeNot 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=AK73836AK0710017-01Endeavor Providence Bronze HDHP 3300Standard Bronze On Exchange Plan0.62828673YesYesNo1003300.000.003300.00300.003300.000.001800.0060.001930.000.000.000.000006600.00$6600 per person$13200 per group$19,800 $19800 per person$39600 per groupNot Applicableper person not applicableper group not applicable3300.00per person not applicable$6600 per group50$9,900 per person not applicable$19800 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze_HDHP_3300_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710018Endeavor Select Bronze HDHP 330073836AK071AKN001AKS001AKF007NewPPOExpanded BronzeNot 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=AK73836AK0710018-00Endeavor Select Bronze HDHP 3300Standard Bronze Off Exchange Plan0.62828673YesYesNo1003300.000.003300.00300.003300.000.001800.0060.001930.000.000.000.000006600.00$6600 per person$13200 per group$19,800 $19800 per person$39600 per groupNot Applicableper person not applicableper group not applicable3300.00per person not applicable$6600 per group50$9,900 per person not applicable$19800 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710018Endeavor Select Bronze HDHP 330073836AK071AKN001AKS001AKF007NewPPOExpanded BronzeNot 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=AK73836AK0710018-01Endeavor Select Bronze HDHP 3300Standard Bronze On Exchange Plan0.62828673YesYesNo1003300.000.003300.00300.003300.000.001800.0060.001930.000.000.000.000006600.00$6600 per person$13200 per group$19,800 $19800 per person$39600 per groupNot Applicableper person not applicableper group not applicable3300.00per person not applicable$6600 per group50$9,900 per person not applicable$19800 per groupNot Applicableper person not applicableper group not applicableYesNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze_HDHP_3300_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710016Endeavor Select Bronze 550073836AK071AKN001AKS001AKF005NewPPOExpanded BronzeNot 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=AK73836AK0710016-00Endeavor Select Bronze 5500Standard Bronze Off Exchange Plan0.629149713YesYesNo1005500.000.001900.00300.005310.00400.00300.0060.001460.00200.0030.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable5500.00$5500 per person$11000 per group40$16,500 $16500 per person$33000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710016Endeavor Select Bronze 550073836AK071AKN001AKS001AKF005NewPPOExpanded BronzeNot 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=AK73836AK0710016-01Endeavor Select Bronze 5500Standard Bronze On Exchange Plan0.629149713YesYesNo1005500.000.001900.00300.005310.00400.00300.0060.001460.00200.0030.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable5500.00$5500 per person$11000 per group40$16,500 $16500 per person$33000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Select_Bronze5500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Select_Bronze5500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710015Endeavor Providence Bronze 550073836AK071AKN002AKS001AKF005NewPPOExpanded BronzeNot 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=AK73836AK0710015-00Endeavor Providence Bronze 5500Standard Bronze Off Exchange Plan0.629149713YesYesNo1005500.000.001900.00300.005310.00400.00300.0060.001460.00200.0030.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable5500.00$5500 per person$11000 per group40$16,500 $16500 per person$33000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf
2018AK73836HIOS09/02/2017 02:21:00 AMSHOP (Small Group)No93-098930773836AK0710015Endeavor Providence Bronze 550073836AK071AKN002AKS001AKF005NewPPOExpanded BronzeNot 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=AK73836AK0710015-01Endeavor Providence Bronze 5500Standard Bronze On Exchange Plan0.629149713YesYesNo1005500.000.001900.00300.005310.00400.00300.0060.001460.00200.0030.000.000007350.00$7350 per person$14700 per group$22,050 $22050 per person$44100 per groupNot Applicableper person not applicableper group not applicable5500.00$5500 per person$11000 per group40$16,500 $16500 per person$33000 per groupNot Applicableper person not applicableper group not applicableNoNohttps://www.modahealth.com/pdfs/sbcs/ak/170101/Moda_Endeavor_Providence_Bronze5500_SBC_SG_2018_AK.pdfhttps://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_Endeavor_Providence_Bronze5500_SG_2018_AK.pdf
2018AK74819HIOS08/08/2017 02:20:00 AMSHOP (Small Group)Yes95-604239074819AK0010007BESTDental Premium74819AK001AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Guaranteed Rate01/01/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0010007-00BESTDental PremiumStandard 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
2018AK74819HIOS08/08/2017 02:20:00 AMIndividualYes95-604239074819AK0020003BESTOne Advantage Gold74819AK002AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AM12/31/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0020003-00BESTOne Advantage GoldStandard 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 person$150 per grouphttps://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf
2018AK74819HIOS08/08/2017 02:20:00 AMIndividualYes95-604239074819AK0020003BESTOne Advantage Gold74819AK002AKN001AKS001ExistingPPOHighNot ApplicableBothNoAllows Adult and Child-Only1Estimated Rate01/01/2018 12:00:00 AM12/31/2018 12:00:00 AMNoYesFullYeshttp://www.bestlife.com/exchange/payment_option.html74819AK0020003-01BESTOne Advantage GoldStandard 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 person$150 per grouphttps://www.bestlife.com/ak/current/AK_BESTOne_Dental_Advantage-Gold_Plan.pdf
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