| 2018 | AL | 44580 | HIOS | 08/08/2017 02:20:00 AM | Individual | Yes | 39-1263473 | 44580AL0380001 | Humana Dental Smart Choice - Low | 44580AL038 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | On the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 0.9877 | 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 | | 44580AL0380001-01 | Humana Dental Smart Choice - Low | Standard Low On Exchange Plan | 69.9 | | | | 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=3110237 |
| 2018 | AZ | 77352 | HIOS | 08/09/2017 02:20:00 AM | Individual | Yes | 95-6042390 | 77352AZ0020003 | BESTOne Advantage Gold | 77352AZ002 | | AZN001 | AZS001 | | Existing | PPO | High | 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 | | 77352AZ0020003-00 | BESTOne Advantage Gold | Standard High Off Exchange Plan | 86.2 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | $700 | $700 per person | $1400 per group | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | http://www.bestlife.com/AZ/current/AZ_BESTOne_Dental_Advantage-Gold_Plan.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0370001 | Blue Value Gold | 46944AL037 | 7346243505 | ALN001 | ALS001 | ALF005 | Existing | PPO | Gold | 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 | 46944AL0370001-00 | Blue Value Gold | Standard Gold Off Exchange Plan | 76.91 | | No | Yes | Yes | 95 | 5 | 750.00 | 600.00 | 0.00 | 60.00 | 20.00 | 800.00 | 0.00 | 400.00 | 750.00 | 100.00 | 40.00 | 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 | $750 | $750 per person | $1500 per group | 20 | $750 | $750 per person | $1500 per group | 20 | $1,500 | $1500 per person | $3000 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/2018vgi.pdf | https://www.alabamablue.com/bb/2018vgi.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | SHOP (Small Group) | No | 63-0103830 | 46944AL0280001 | Blue Choice Platinum for Business | 46944AL028 | 7346243505 | ALN001 | ALS001 | ALF002 | Existing | PPO | Platinum | Not Applicable | Yes | Both | No | No | | | | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 0.9986 | | | 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 | 46944AL0280001-00 | Blue Choice Platinum for Business | Standard Platinum Off Exchange Plan | 87.79 | | No | Yes | No | 100 | | 0.00 | 300.00 | 0.00 | 60.00 | 20.00 | 700.00 | 0.00 | 400.00 | 100.00 | 80.00 | 200.00 | 0.00 | | 5 | 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 | $100 | $100 per person | $200 per group | 20 | | | | | $100 | $100 per person | $200 per group | Not Applicable | per person not applicable | per group not applicable | 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/b2018BlueChoicePlatinum | https://www.AlabamaBlue.com/b2018BlueChoicePlatinum |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | Yes | 63-0103830 | 46944AL0500001 | Dental Blue Plus | 46944AL050 | 7346243505 | ALN002 | ALS002 | | Existing | PPO | Low | Not Applicable | | On the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | No | | Yes | Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service. | No | https://sso.bcbsal.org/sp/ACS.saml2 | | 46944AL0500001-01 | Dental Blue Plus | Standard Low On Exchange Plan | 69.34 | | | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | $40 | $40 per person | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.AlabamaBlue.com/bb/2018dbp.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | SHOP (Small Group) | No | 63-0103830 | 46944AL0280001 | Blue Choice Platinum for Business | 46944AL028 | 7346243505 | ALN001 | ALS001 | ALF002 | Existing | PPO | Platinum | Not Applicable | Yes | Both | No | No | | | | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 0.9986 | | | 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 | 46944AL0280001-01 | Blue Choice Platinum for Business | Standard Platinum On Exchange Plan | 87.79 | | No | Yes | No | 100 | | 0.00 | 300.00 | 0.00 | 60.00 | 20.00 | 700.00 | 0.00 | 400.00 | 100.00 | 80.00 | 200.00 | 0.00 | | 5 | 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 | $100 | $100 per person | $200 per group | 20 | | | | | $100 | $100 per person | $200 per group | Not Applicable | per person not applicable | per group not applicable | 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/b2018BlueChoicePlatinum | https://www.AlabamaBlue.com/b2018BlueChoicePlatinum |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0370001 | Blue Value Gold | 46944AL037 | 7346243505 | ALN001 | ALS001 | ALF005 | Existing | PPO | Gold | 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 | 46944AL0370001-01 | Blue Value Gold | Standard Gold On Exchange Plan | 76.91 | | No | Yes | Yes | 95 | 5 | 750.00 | 600.00 | 0.00 | 60.00 | 20.00 | 800.00 | 0.00 | 400.00 | 750.00 | 100.00 | 40.00 | 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 | $750 | $750 per person | $1500 per group | 20 | $750 | $750 per person | $1500 per group | 20 | $1,500 | $1500 per person | $3000 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/2018vgi.pdf | https://www.alabamablue.com/bb/2018vgi.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0370001 | Blue Value Gold | 46944AL037 | 7346243505 | ALN001 | ALS001 | ALF005 | Existing | PPO | Gold | 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 | 46944AL0370001-02 | Blue Value Gold | 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/2018vgi-nocost.pdf | https://www.alabamablue.com/bb/2018vgi-nocost.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0370001 | Blue Value Gold | 46944AL037 | 7346243505 | ALN001 | ALS001 | ALF005 | Existing | PPO | Gold | 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 | 46944AL0370001-03 | Blue Value Gold | Limited Cost Sharing Plan Variation | 76.91 | | No | Yes | Yes | 95 | 5 | 750.00 | 600.00 | 0.00 | 60.00 | 20.00 | 800.00 | 0.00 | 400.00 | 750.00 | 100.00 | 40.00 | 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 | $750 | $750 per person | $1500 per group | 20 | $750 | $750 per person | $1500 per group | 20 | $1,500 | $1500 per person | $3000 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/2018vgi-limited.pdf | https://www.alabamablue.com/bb/2018vgi-limited.pdf |
| 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 | 46944AL0340001-01 | Blue Access Gold for Business | Standard Gold On 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 | 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 | 46944AL0310001-00 | Blue HSA Gold for Business | Standard Gold Off 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 | 46944AL0430001 | Blue Saver Bronze for Business | 46944AL043 | 7346243505 | ALN001 | ALS001 | ALF010 | Existing | PPO | Bronze | 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_1.0.pdf | 46944AL0430001-01 | Blue Saver Bronze for Business | Standard Bronze On Exchange Plan | 61.07 | | Yes | Yes | No | 100 | | 7150.00 | 0.00 | 0.00 | 60.00 | 600.00 | 1000.00 | 0.00 | 400.00 | 1400.00 | 80.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 7150.00 | $7150 per person | $14300 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 7150.00 | $7150 per person | $14300 per group | 0 | | | | | $14,300 | $14300 per person | $28600 per group | Not Applicable | per person not applicable | per group not applicable | No | No | | https://www.AlabamaBlue.com/b2018BlueSaverBronze | https://www.AlabamaBlue.com/b2018BlueSaverBronze |
| 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 | 46944AL0410001-05 | Blue Value Silver | 87% AV Level Silver Plan | 87.8 | | No | Yes | Yes | 95 | 5 | 400.00 | 0.00 | 1100.00 | 60.00 | 20.00 | 800.00 | 0.00 | 400.00 | 400.00 | 100.00 | 100.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 1500.00 | $1500 per person | $3000 per group | 1500.00 | $1500 per person | $3000 per group | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | $400 | $400 per person | $800 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-87.pdf | https://www.alabamablue.com/bb/2018vsi-87.pdf |
| 2018 | AL | 82285 | HIOS | 08/12/2017 02:21:00 AM | SHOP (Small Group) | Yes | 94-2761537 | 82285AL0020001 | Delta Dental PPO Pediatric Basic Plan for Small Businesses | 82285AL002 | | ALN001 | ALS001 | | Existing | PPO | Low | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2017 12:00:00 AM | | No | | Yes | Nationwide network | Yes | https://www.deltadentalins.com/hx/checkout | | 82285AL0020001-00 | Delta Dental PPO Pediatric Basic Plan for Small Businesses | 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/82285al0020001-18 |
| 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 | 46944AL0410001-06 | Blue Value Silver | 94% AV Level Silver Plan | 94.74 | | No | Yes | Yes | 95 | 5 | 100.00 | 0.00 | 500.00 | 60.00 | 20.00 | 400.00 | 0.00 | 400.00 | 100.00 | 50.00 | 80.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 550.00 | $550 per person | $1100 per group | 550.00 | $550 per person | $1100 per group | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | $100 | $100 per person | $200 per group | 10 | Not Applicable | per person not applicable | per group not applicable | 10 | $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-94.pdf | https://www.alabamablue.com/bb/2018vsi-94.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | SHOP (Small Group) | No | 63-0103830 | 46944AL0380001 | Blue Secure Silver for Business | 46944AL038 | 7346243505 | ALN001 | ALS001 | ALF008 | Existing | PPO | Silver | 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_1.0.pdf | 46944AL0380001-00 | Blue Secure Silver for Business | Standard Silver Off Exchange Plan | 71.81 | | No | Yes | Yes | 95 | 5 | 2600.00 | 800.00 | 0.00 | 60.00 | 20.00 | 1000.00 | 0.00 | 400.00 | 1300.00 | 200.00 | 0.00 | 0.00 | | 5 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | 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 | $2,600 | $2600 per person | $5200 per group | 20 | $2,600 | $2600 per person | $5200 per group | 20 | $2,600 | $2600 per person | $5200 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/b2018BlueSecureSilver | https://www.AlabamaBlue.com/b2018BlueSecureSilver |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0660001 | Blue Cross Select Silver | 46944AL066 | 7346243505 | ALN001 | ALS001 | ALF202 | New | PPO | Silver | Not Applicable | Yes | Both | No | Yes | All specialists seen in an office setting, excluding OB/GYN. | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If 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 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 | 46944AL0660001-00 | Blue Cross Select Silver | Standard Silver Off Exchange Plan | 70.18 | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | 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 | $2,800 | $2800 per person | $5600 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,600 | $5600 per person | $11200 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/2018css.pdf | https://www.alabamablue.com/bb/2018css.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0660001 | Blue Cross Select Silver | 46944AL066 | 7346243505 | ALN001 | ALS001 | ALF202 | New | PPO | Silver | Not Applicable | Yes | Both | No | Yes | All specialists seen in an office setting, excluding OB/GYN. | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If 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 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 | 46944AL0660001-01 | Blue Cross Select Silver | Standard Silver On Exchange Plan | 70.18 | | 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 | | | | | | | | | | | | | | | | | | | | | | | | | 7350.00 | $7350 per person | $14700 per group | 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 | $2,800 | $2800 per person | $5600 per group | 20 | Not Applicable | per person not applicable | per group not applicable | 20 | $5,600 | $5600 per person | $11200 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/2018css.pdf | https://www.alabamablue.com/bb/2018css.pdf |
| 2018 | AL | 46944 | HIOS | 09/22/2017 02:20:00 AM | Individual | No | 63-0103830 | 46944AL0660001 | Blue Cross Select Silver | 46944AL066 | 7346243505 | ALN001 | ALS001 | ALF202 | New | PPO | Silver | Not Applicable | Yes | Both | No | Yes | All specialists seen in an office setting, excluding OB/GYN. | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes, Pregnancy | 1 | | | 01/01/2018 12:00:00 AM | | Yes | If 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 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 | 46944AL0660001-02 | Blue Cross Select 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/2018css-nocost.pdf | https://www.alabamablue.com/bb/2018css-nocost.pdf |
| 2018 | AL | 73301 | HIOS | 11/01/2017 02:20:00 AM | Individual | No | 32-0509107 | 73301AL0020006 | Bronze HSA | 73301AL002 | | ALN001 | ALS001 | ALF006 | New | EPO | Bronze | Not Applicable | Yes | Both | No | No | | | 0.00 | No | Allows Adult and Child-Only | | Yes | Asthma, Heart Disease, Diabetes | 1 | | | 01/01/2018 12:00:00 AM | | Yes | Emergency coverage only | Yes | Emergency coverage only | No | https://enroll.brighthealthplan.com/ehp/eapp/samlpaymentacs | https://cdn1.brighthealthplan.com/docs/formulary/2018-al-comm-formulary-en.pdf | 73301AL0020006-03 | Bronze HSA | Limited Cost Sharing Plan Variation | 61 | | Yes | Yes | No | 100 | | 6650.00 | 0.00 | 0.00 | 60.00 | 6650.00 | 0.00 | 0.00 | 55.00 | 1925.00 | 0.00 | 0.00 | 0.00 | | 0 | 0 | 0 | | | | | | | | | | | | | | | | | | | | | | | | | 6650.00 | $6650 per person | $13300 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 6650.00 | $6650 per person | $13300 per group | 0 | | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | Yes | | | https://cdn1.brighthealthplan.com/docs/SBCs/SBC_ENG_BRIGHTHEALTH_73301AL0020006_03_20170731.pdf | https://cdn1.brighthealthplan.com/docs/2018-COCs/2018BHALBronzeHSACOC.pdf |
