2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010009 | BESTDental Standard - L | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf | | 12538AL0010009-00 | BESTDental Standard - L | Standard Low Off Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Standard-L_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 12538AL0020005 | BESTOne Plus Silver | 12538AL002 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | 12/31/2018 12:00:00 AM | No | | Yes | Full | Yes | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf | | 12538AL0020005-00 | BESTOne Plus Silver | Standard Low Off Exchange Plan | 70 | | | | 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/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 12538AL0020005 | BESTOne Plus Silver | 12538AL002 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | 12/31/2018 12:00:00 AM | No | | Yes | Full | Yes | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf | | 12538AL0020005-01 | BESTOne Plus Silver | Standard Low On Exchange Plan | 70 | | | | 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/AL/current/AL_BESTOne_Dental_Advantage-Gold_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010009 | BESTDental Standard - L | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Plus-Silver_Plan.pdf | | 12538AL0010009-01 | BESTDental Standard - L | Standard Low On Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Standard-L_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010011 | BESTDental Choice - L | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0010011-00 | BESTDental Choice - L | Standard Low Off Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Choice-L_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 12538AL0020006 | BESTOne Basic Silver | 12538AL002 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | 12/31/2018 12:00:00 AM | No | | Yes | Full | Yes | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0020006-00 | BESTOne Basic Silver | Standard Low Off Exchange Plan | 70 | | | | 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/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 12538AL0020006 | BESTOne Basic Silver | 12538AL002 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | 12/31/2018 12:00:00 AM | No | | Yes | Full | Yes | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0020006-01 | BESTOne Basic Silver | Standard Low On Exchange Plan | 70 | | | | 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/AL/current/AL_BESTOne_Dental_Plus-Gold_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010011 | BESTDental Choice - L | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0010011-01 | BESTDental Choice - L | Standard Low On Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Choice-L_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010012 | BESTDental Value | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0010012-00 | BESTDental Value | Standard Low Off Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Value_Plan.pdf |
2018 | AL | 12538 | HIOS | 08/08/2017 02:20:00 AM | SHOP (Small Group) | Yes | 95-6042390 | 12538AL0010012 | BESTDental Value | 12538AL001 | | ALN001 | ALS001 | | 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 | https://www.bestlife.com/AL/2017/AL_BESTOne_Dental_Basic-Silver_Plan.pdf | | 12538AL0010012-01 | BESTDental Value | Standard Low On Exchange Plan | 70 | | | | 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/al/CURRENT/AL_BESTDental_Value_Plan.pdf |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0410001 | Blue Value Silver | 46944AL041 | 7346243505 | ALN001 | ALS001 | ALF007 | Existing | PPO | Silver | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf | 46944AL0410001-00 | Blue Value Silver | Standard Silver Off Exchange Plan | 71.79 | | No | Yes | Yes | 95 | 5 | 2600.00 | 40.00 | 1800.00 | 60.00 | 20.00 | 1100.00 | 0.00 | 400.00 | 1300.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6850.00 | $6850 per person | $13700 per group | 6850.00 | $6850 per person | $13700 per group | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | $2,600 | $2600 per person | $5200 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,200 | $5200 per person | $10400 per group | Not Applicable | per person not applicable | per group not applicable | 0.00 | $0 per person | $0 per group | 0 | 0.00 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | No | | | https://www.alabamablue.com/sb/2018vsi.pdf | https://www.alabamablue.com/bb/2018vsi.pdf |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0410001 | Blue Value Silver | 46944AL041 | 7346243505 | ALN001 | ALS001 | ALF007 | Existing | PPO | Silver | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf | 46944AL0410001-01 | Blue Value Silver | Standard Silver On Exchange Plan | 71.79 | | No | Yes | Yes | 95 | 5 | 2600.00 | 40.00 | 1800.00 | 60.00 | 20.00 | 1100.00 | 0.00 | 400.00 | 1300.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6850.00 | $6850 per person | $13700 per group | 6850.00 | $6850 per person | $13700 per group | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | $2,600 | $2600 per person | $5200 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,200 | $5200 per person | $10400 per group | Not Applicable | per person not applicable | per group not applicable | 0.00 | $0 per person | $0 per group | 0 | 0.00 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | No | | | https://www.alabamablue.com/sb/2018vsi.pdf | https://www.alabamablue.com/bb/2018vsi.pdf |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | SHOP (Small Group) | No | 63-0103830 | 46944AL0310001 | Blue HSA Gold for Business | 46944AL031 | 7346243505 | ALN001 | ALS001 | ALF006 | Existing | PPO | Gold | Not Applicable | No | Both | No | No | | | | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 0.9998 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf | 46944AL0310001-01 | Blue HSA Gold for Business | Standard Gold On Exchange Plan | | 0.787435849 | Yes | Yes | No | 100 | | 1600.00 | 0.00 | 1100.00 | 60.00 | 1600.00 | 0.00 | 500.00 | 400.00 | 1600.00 | 0.00 | 30.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 4000.00 | $4000 per person | $8000 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 1600.00 | $3200 per person | $3200 per group | 10 | | | | | $1,600 | $3200 per person | $3200 per group | Not Applicable | per person not applicable | per group not applicable | Yes | No | | https://www.AlabamaBlue.com/b2018BlueHSAGold | https://www.AlabamaBlue.com/b2018BlueHSAGold |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | SHOP (Small Group) | No | 63-0103830 | 46944AL0340001 | Blue Access Gold for Business | 46944AL034 | 7346243505 | ALN001 | ALS001 | ALF004 | Existing | PPO | Gold | Not Applicable | Yes | Both | No | No | | | | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 0.9998 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_2.0.pdf | 46944AL0340001-00 | Blue Access Gold for Business | Standard Gold Off Exchange Plan | 78.56 | | No | Yes | Yes | 95 | 5 | 600.00 | 500.00 | 0.00 | 60.00 | 20.00 | 700.00 | 0.00 | 400.00 | 600.00 | 100.00 | 60.00 | 0.00 | | 5 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6000.00 | $6000 per person | $12000 per group | 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 | $600 | $600 per person | $1200 per group | 20 | $600 | $600 per person | $1200 per group | 20 | $600 | $600 per person | $1200 per group | Not Applicable | per person not applicable | per group not applicable | 0.00 | $0 per person | $0 per group | 0 | 0.00 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | No | No | | https://www.AlabamaBlue.com/b2018BlueAccessGold | https://www.AlabamaBlue.com/b2018BlueAccessGold |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0410001 | Blue Value Silver | 46944AL041 | 7346243505 | ALN001 | ALS001 | ALF007 | Existing | PPO | Silver | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf | 46944AL0410001-02 | Blue Value Silver | Zero Cost Sharing Plan Variation | 100 | | No | Yes | Yes | 95 | 5 | 0.00 | 0.00 | 0.00 | 60.00 | 0.00 | 0.00 | 0.00 | 400.00 | 0.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 0.00 | $0 per person | $0 per group | 0.00 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | $0 | $0 per person | $0 per group | 0.00 | $0 per person | $0 per group | 0 | 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.alabamablue.com/sb/2018vsi-nocost.pdf | https://www.alabamablue.com/bb/2018vsi-nocost.pdf |
2018 | AL | 44580 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 39-1263473 | 44580AL0380002 | Humana Dental Smart Choice - High | 44580AL038 | | ALN001 | ALS001 | | New | PPO | High | Not Applicable | | On the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 0.9861 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services. | Yes | Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services. | Yes | https://www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage | | 44580AL0380002-01 | Humana Dental Smart Choice - High | Standard High On Exchange Plan | 83.3 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $35 | per person not applicable | per group not applicable | | | | | | $35 | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | http://apps.humana.com/marketing/documents.asp?file=3110224 |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0410001 | Blue Value Silver | 46944AL041 | 7346243505 | ALN001 | ALS001 | ALF007 | Existing | PPO | Silver | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf | 46944AL0410001-03 | Blue Value Silver | Limited Cost Sharing Plan Variation | 71.79 | | No | Yes | Yes | 95 | 5 | 2600.00 | 40.00 | 1800.00 | 60.00 | 20.00 | 1100.00 | 0.00 | 400.00 | 1300.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6850.00 | $6850 per person | $13700 per group | 6850.00 | $6850 per person | $13700 per group | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | $2,600 | $2600 per person | $5200 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,200 | $5200 per person | $10400 per group | Not Applicable | per person not applicable | per group not applicable | 0.00 | $0 per person | $0 per group | 0 | 0.00 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | No | | | https://www.alabamablue.com/sb/2018vsi-limited.pdf | https://www.alabamablue.com/bb/2018vsi-limited.pdf |
2018 | AL | 82285 | HIOS | 08/12/2017 02:21:00 AM | Individual | Yes | 94-2761537 | 82285AL0010001 | Delta Dental PPO Pediatric Basic Plan | 82285AL001 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | No | | Yes | Nationwide network | Yes | https://www.deltadentalins.com/hx/checkout | | 82285AL0010001-00 | Delta Dental PPO Pediatric Basic Plan | Standard Low Off Exchange Plan | 70.6 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $50 | $50 per person | per group not applicable | | | | | | $50 | $50 per person | per group not applicable | $50 | $50 per person | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://deltadentalins.com/hcx/al/82285al0010001-18 |
2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0410001 | Blue Value Silver | 46944AL041 | 7346243505 | ALN001 | ALS001 | ALF007 | Existing | PPO | Silver | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. | Yes | If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. | Yes | https://sso.bcbsal.org/sp/ACS.saml2 | https://www.myprime.com/content/dam/prime/memberportal/forms/AuthorForms/HIM/2018/2018_AL_6T_Source+Rx_1.0.pdf | 46944AL0410001-04 | Blue Value Silver | 73% AV Level Silver Plan | 73.79 | | No | Yes | Yes | 95 | 5 | 1950.00 | 40.00 | 1800.00 | 60.00 | 20.00 | 1100.00 | 0.00 | 400.00 | 1300.00 | 200.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 5850.00 | $5850 per person | $11700 per group | 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 | $1,950 | $1950 per person | $3900 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,200 | $5200 per person | $10400 per group | Not Applicable | per person not applicable | per group not applicable | 0.00 | $0 per person | $0 per group | 0 | 0.00 | $0 per person | $0 per group | 0 | $0 | $0 per person | $0 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | No | | | https://www.alabamablue.com/sb/2018vsi-73.pdf | https://www.alabamablue.com/bb/2018vsi-73.pdf |
2018 | AL | 18756 | HIOS | 05/25/2017 02:20:00 AM | SHOP (Small Group) | Yes | 13-5581829 | 18756AL0140001 | EHB Basic Dental Plan (Low) | 18756AL014 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Off the Exchange | | | | When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate. | | No | Allows Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided. | Yes | The PPO plan has an indemnity schedule of benefits for out of service area coverage. | Yes | | | 18756AL0140001-00 | EHB Basic Dental Plan (Low) | Standard Low Off Exchange Plan | 70 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $100 | per person not applicable | per group not applicable | | | | | | $100 | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |