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[null,null,null,null,null,null,"Group Name:  ",null,null,null,"Group County:  ",null,null,"HSA:",null,null,null,"Select Medical Plans",null,null,"Select Dental Plan",null,"Orthodontic Rider",null,"Plan ID","Deductible","Copay","Coins","Plan Code"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Waive"]
[null,null,null,null,null,null,"Group Tax ID Number:  ",null,null,null,"BCBSAZ Group #:  ",null,null,"HRA:",null,null,"Plan 1",null,null,{"$f":"IF(OR(U3=\"Custom Dental 1\",U3=\"Custom Dental 2\",U3=\"Custom Dental 3\",U3=\"Custom Dental 4\"),\"X\",\"\")","v":""},null,null,null,{"$f":"IF(TRIM(U3)<>\"\",VLOOKUP(U3,CV:DG,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,"Effective Date:  ",null,null,null,"Group NAICS:  ",null,null,"FSA:",null,null,"Plan 2",null,null,{"$f":"IF(OR(U4=\"Custom Dental 1\",U4=\"Custom Dental 2\",U4=\"Custom Dental 3\",U4=\"Custom Dental 4\"),\"X\",\"\")","v":""},null,null,null,{"$f":"IF(TRIM(U4)<>\"\",VLOOKUP(U4,CV:DG,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,"Non-Eligible:  ",null,null,"DCFSA:",null,null,"Plan 3",null,null,"",null,null,null,{"$f":"IF(TRIM(U5)<>\"\",VLOOKUP(U5,CV:DG,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,"*Complete all yellow highlighted columns",null,null,null,null,null,null,"LPFSA:",null,null,"Plan 4",null,null,"",null,null,null,{"$f":"IF(TRIM(U6)<>\"\",VLOOKUP(U6,CV:DG,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,"*No blank rows between employees/families",null,null,null,null,null,null,null,null,null,"Plan 5"]
[null,null,null,null,null,null,"*When doing copy & paste follow the required format indicated",null,null,null,"51to99v.1_012023",null,null,null,null,null,"Plan 6",null,null,{"$f":"COUNTIF(T2:T5,\"=x\")","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Plan 7",null,null,{"$f":"COUNTIF(T3:T6,\"=x\")","v":0}]
["SW Line",null,"Dental Dep line","Dpt Count","Dental Line","Enr Line","* Relationship to Employee\n(select from drop down list)","* Last Name","* First Name","Medical Waiver Reason (employee/dependents)\n(select from drop down list)","* Date of Birth (mm/dd/yyyy)","* Gender\n(F / M)","* SSN \n(without dashes)","* Address 1","* City","* State","* Zip","* County for AZ residences only","* Medical Plan Description\n(select from drop down list)","* Medical Coverage Level\n(select from drop down list)","* Number of dependents to be covered \n(include spouse)","* Employment Status\n(select from drop down list)","Dental Plan","Dental Orthodontic Rider","Dental Coverage Level\n(select from drop down list)","Cobra Qualifying Event\n(select from drop down list)","Cobra Qualifying Event Date","Cobra Begin Date","Cobra End Date","HSA \n(Y / N)","HSA \nAmount","HRA \n(Y / N)","HRA \nAmount","FSA\n(Y / N)","FSA\nAmount","DCFSA\n(Y / N)","DCFSA\nAmount","LPFSA\n(Y / N)","LPFSA\nAmount","Phone Number","Work Number","Work Ext.","Married\n(Y / N)","Date of Hire","EE ID#","MID","Class Code / Salary Grade","Location or Division","Disabled Dependent\n(Y / N)","HSA Indicator","HRA Indicator","FSA Indicator","DCFSA Indicator","LPFSA Indicator","Employee SSN","Benefit Begin Date","Emp Coverage Level","Plan Code","Deductible","Copay","Coinsurance","Network","SW Relationship","SW Coverage","SW No Write State","SW Area","SW Dental coverage","Group Dental Indicator","Dental Plan Code","Dental Deductible","Dental Copay","Dental Coinsurance","Dental Network","Dental Coverage Level","Dental Plan ID","SSN Length","Relationship Code","Medical","Dental Name","Dental ONLY","Dental Rider Allowed","Overage Dep","Relationship to Employee","SW Relationship","Gender","Employment Status ","Coverage Level","SW Coverage Type","Coverage Level","Disabled Dependent","COBRA Life Events","Waiver Reason","SW Code","No Write States","SW Code","SW Area (code)","SW Area (county)","Effective","End","Product Display Name","Carrier Plan Code","Deductible","Copay","Coinsurance","Network","H.S.A.","FSA","FSAD","HRA","Plan ID","Ortho Ind"]
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[1,{"$f":"IF(TRIM(G12)<>\"\",IF(J12<>\"\",B11,IF(R3<>\"\",A12,0)),A12)","v":1},{"$f":"IF(TRIM(BP12)=\"Y\",MAX(B:B)+1,\"\")","v":""},null,{"$f":"IF(TRIM(G12)=\"\",\"\",IF(AND(BP12=\"Y\",W12<>\"\",W12<>\"Waive\"),C12,\"\"))","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(CB12=\"Y\",0,IF(TRIM(J12)<>\"\",0,B12)))","v":false},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(HSA=\"Y\",IF(AD12=\"\",\"N\",IF(G12=\"EMPLOYEE\",AD12,AX10)),\"N\")","v":"N"},{"$f":"IF(HRA=\"Y\",IF(AF12=\"\",\"N\",IF(G12=\"EMPLOYEE\",AF12,AY10)),\"N\")","v":"N"},{"$f":"IF(FSA=\"Y\",IF(AH12=\"\",\"N\",IF(G12=\"EMPLOYEE\",AH12,AZ10)),\"N\")","v":"N"},{"$f":"IF(DCFSA=\"Y\",IF(AJ12=\"\",\"N\",IF(G12=\"EMPLOYEE\",AJ12,BA10)),\"N\")","v":"N"},{"$f":"IF(LPFSA=\"Y\",IF(AL12=\"\",\"N\",IF(G12=\"EMPLOYEE\",AL12,BB10)),\"N\")","v":"N"},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",M12,BC11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(I4)<>\"\",I4,\"\"),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",VLOOKUP(T12,CI:CK,3,FALSE),BE11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(R12)<>\"\",VLOOKUP(R12,CV:CW,2,FALSE),\"\"),BF11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(R12)<>\"\",VLOOKUP(R12,CV:DA,3,FALSE),\"\"),BG11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(R12)<>\"\",VLOOKUP(R12,CV:DA,4,FALSE),\"\"),BH11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(R12)<>\"\",VLOOKUP(R12,CV:DA,5,FALSE),\"\"),BI11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(R12)<>\"\",VLOOKUP(R12,CV:DA,6,FALSE),\"\"),BJ11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",VLOOKUP(G12,CE:CF,2,FALSE),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(CB12=\"Y\",\"Non Eligible\",IF(TRIM(BY12)=\"employee\",IF(J12<>\"\",VLOOKUP(J12,CN:CO,2,FALSE),VLOOKUP(T12,CI:CJ,2,FALSE)),BL11)),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(J12)=\"\",IF(VLOOKUP(P12,CP:CQ,2,FALSE)<>\"Yes\",\"\",\"Yes\"),\"\"),BM11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(TRIM(BY12)=\"employee\",IF(TRIM(J12)=\"\",IF(TRIM(P12)=\"AZ\",\"\",VLOOKUP(P12,CP:CR,3,FALSE)),\"\"),BN11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(BP12=\"\",BL12,IF(W12<>\"\",IF(W12=\"waive\",\"No Coverage\",\"AHP Eligible\"),\"No Coverage\")),\"\")","v":""},{"$f":"IF(TRIM(U3)<>\"\",\"Y\",\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"waive\"),VLOOKUP(CA12,CV:CW,2,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"WAIVE\"),VLOOKUP(CA12,CV:DA,3,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"WAIVE\"),VLOOKUP(CA12,CV:DA,4,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"WAIVE\"),VLOOKUP(CA12,CV:DA,5,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"WAIVE\"),VLOOKUP(CA12,CV:DA,6,FALSE),\"\"),\"\")","v":""},{"$f":"IF(AND(TRIM(G12)<>\"\",BP12=\"Y\"),IF(TRIM(BY12)=\"employee\",IF(Y12<>\"\",VLOOKUP(Y12,CI:CK,3,FALSE),BE12),BV11),\"\")","v":""},{"$f":"IF(TRIM(G12)<>\"\",IF(AND(TRIM(W12)<>\"\",TRIM(W12)<>\"WAIVE\"),VLOOKUP(CA12,CV:DF,11,FALSE),\"\"),\"\")","v":""},{"$f":"LEN(M12)","v":0},{"$f":"IF(G12<>\"\",IF(AND(G12<>\"employee\",G12<>\"spouse\",G12<>\"child\",G12<>\"life partner\"),IF(G12=\"ee\",\"Employee\",IF(G12=\"sp\",\"Spouse\",IF(G12=\"ch\",\"Child\",IF(G12=\"dp\",\"Life Partner\",\"ERROR\")))),G12),\"\")","v":""},{"$f":"IF(BY12<>\"\",IF(BY12=\"employee\",BL12,BZ11),\"\")","v":""},{"$f":"IF(BP12=\"N\",\"\",IF(W12<>\"\",IF(X12<>\"waive\",IF(X12<>\"\",CONCATENATE(W12,\" ortho \",X12),W12),W12),\"\"))","v":""},{"$f":"IF(R3<>\"\",\"N\",IF(U3<>\"\",\"Y\",\"N\"))","v":"N"},{"$f":"IF(TRIM(W12)<>\"\",IF(TRIM(W12)<>\"waive\",IF(TRIM(X12)<>\"\",VLOOKUP(W12,CV:DG,12,FALSE),\"\"),\"\"),\"\")","v":""},{"$f":"IF(G12=\"child\",IF(((EffectiveDate-K12)/365)>25,\"Overage\",\"\"),\"\")","v":""},"Spouse","Spouse","F","Part Time","Employee + Spouse","AHP Eligible","ESP","N","Reduction of work hours","B – Covered by spouse’s or parent’s employer group plan","Other Coverage","AK","Yes","ALASKA","Cochise",null,null,"Ascend HMO Plus - Alliance Ntwk $7,000/$25/$100 (70%)","HMO",7000,25,70,"ALI","N","Y","Y","N"]
[2,{"$f":"IF(G13=\"\",\"\",IF(CB13=\"Y\",0,IF(J13<>\"\",B12,IF(G13<>\"EMPLOYEE\",B12+1,B12+1))))","v":""},{"$f":"IF(TRIM(BP13)=\"Y\",IF(E12<>\"\",E12+1,C12))","v":false},{"$f":"IF(TRIM(D12)<>\"\",IF(OR(TRIM(D12)=\"1\",TRIM(D12)=\"0\"),\"\",D12-1),IF(AND(TRIM(U12)<>\"\",TRIM(U12)<>\"0\"),U12,\"\"))","v":""},{"$f":"IF(TRIM(G13)=\"\",IF(TRIM(G12)<>\"\",IF(TRIM(E12)<>\"\",E12+1,C13),IF(AND(BP13=\"Y\",W13<>\"\",W13<>\"Waive\"),C13,\"\")),IF(AND(BP13=\"Y\",W13<>\"\",W13<>\"Waive\"),C13,\"\"))","v":""},{"$f":"IF(TRIM(G13)<>\"\",IF(CB13=\"Y\",0,IF(TRIM(J13)<>\"\",\"\",B13)),IF(F12<>\"\",F12+1,B12+1))","v":1},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","",{"$f":"IF(TRIM(G13)<>\"\",IF(TRIM(BD12)<>\"\",BD12,\"\"),\"\")","v":""},"","","","","","","",{"$f":"IF(TRIM(G13)<>\"\",IF(CB13=\"Y\",\"Non Eligible\",IF(TRIM(BY13)=\"employee\",IF(J13<>\"\",VLOOKUP(J13,CN:CO,2,FALSE),VLOOKUP(T13,CI:CJ,2,FALSE)),IF(J13<>\"\",VLOOKUP(J13,CN:CO,2,FALSE),BZ13))),\"\")","v":""},"","","",{"$f":"BP12","v":""},"","","","","","","",0,"",{"$f":"IF(BY13<>\"\",IF(BY13=\"employee\",BL13,BZ12),\"\")","v":""},"",{"$f":"CB12","v":"N"},"",{"$f":"IF(G13=\"child\",IF(((EffectiveDate-K13)/365)>25,\"Overage\",\"\"),\"\")","v":""},"Child","Dependent",null,"Retiree","Employee + Child","AHP Eligible","ECH",null,"Medicare","C – Covered by TRICARE","Other Coverage","AZ",null,"ARIZONA","Coconino",null,null,"Ascend HMO Plus - Alliance Ntwk $6,000/$25/$75 (70%)","HMO",6000,25,70,"ALI","N","Y","Y","N"]
[3,"",false,{"$f":"IF(TRIM(D13)<>\"\",IF(OR(TRIM(D13)=\"1\",TRIM(D13)=\"0\"),\"\",D13-1),IF(AND(TRIM(U13)<>\"\",TRIM(U13)<>\"0\"),U13,\"\"))","v":""},"",2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","",{"$f":"BP13","v":""},"","","","","","","",0,"","","",{"$f":"CB13","v":"N"},"",{"$f":"IF(G14=\"child\",IF(((EffectiveDate-K14)/365)>25,\"Overage\",\"\"),\"\")","v":""},"Life Partner","Spouse",null,"Cobra","Family","AHP Eligible","FAM",null,"Death","D – Covered by AHCCCS","Other Coverage","AR",null,"ARKANSAS","Gila",null,null,"Ascend HMO Plus - Alliance Ntwk $5,000/$25/$75 (70%)","HMO",5000,25,70,"ALI","N","Y","Y","N"]
[4,"",false,{"$f":"IF(TRIM(D14)<>\"\",IF(OR(TRIM(D14)=\"1\",TRIM(D14)=\"0\"),\"\",D14-1),IF(AND(TRIM(U14)<>\"\",TRIM(U14)<>\"0\"),U14,\"\"))","v":""},"",3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G15=\"child\",IF(((EffectiveDate-K15)/365)>25,\"Overage\",\"\"),\"\")","v":""},"EE","Contract Holder",null,null,null,null,null,null,"Divorce","E – Covered by IHS (Indian Health Services)","Other Coverage","CA",null,"CALIFORNIA","Graham",null,null,"Ascend HMO Plus - Alliance Ntwk $3,000/$25/$60 (70%)","HMO",3000,25,70,"ALI","N","Y","Y","N"]
[5,"",false,"","",4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G16=\"child\",IF(((EffectiveDate-K16)/365)>25,\"Overage\",\"\"),\"\")","v":""},"Sp","Spouse",null,null,null,null,null,null,"Separation","F – Covered by Medicare","Other Coverage","CO",null,"COLORADO","Greenlee",null,null,"Ascend HMO Plus - Alliance Ntwk $7,000/$25/$100 (80%)","HMO",7000,25,80,"ALI","N","Y","Y","N"]
[6,"",false,"","",5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G17=\"child\",IF(((EffectiveDate-K17)/365)>25,\"Overage\",\"\"),\"\")","v":""},"Ch","Dependent",null,null,null,null,null,null,"Ineligible Child","G – Married Co-Workers","Other Coverage","CT",null,"CONNECTICUT","La Paz",null,null,"Ascend HMO Plus - Alliance Ntwk $6,000/$25/$75 (80%)","HMO",6000,25,80,"ALI","N","Y","Y","N"]
[7,"",false,"","",6,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G18=\"child\",IF(((EffectiveDate-K18)/365)>25,\"Overage\",\"\"),\"\")","v":""},"DP","Dependent",null,null,null,null,null,null,null,"H – Individual coverage purchased directly from carrier","Other Coverage","DC",null,"DISTRICT OF COLUMBIA","Maricopa",null,null,"Ascend HMO Plus - Alliance Ntwk $5,000/$25/$75 (80%)","HMO",5000,25,80,"ALI","N","Y","Y","N"]
[8,"",false,"","",7,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G19=\"child\",IF(((EffectiveDate-K19)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,"I – Individual coverage purchased by Healthcare Marketplace","Other Coverage","DE","Yes","DELAWARE","Mohave",null,null,"Ascend HMO Plus - Alliance Ntwk $3,000/$25/$60 (80%)","HMO",3000,25,80,"ALI","N","Y","Y","N"]
[9,"",false,"","",8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G20=\"child\",IF(((EffectiveDate-K20)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"FL",null,"FLORIDA","Navajo",null,null,"Ascend HMO Plus - Alliance Ntwk $8,300/$25/$95 (100%)","HMO",8300,25,100,"ALI","N","Y","Y","N"]
[10,"",false,"","",9,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G21=\"child\",IF(((EffectiveDate-K21)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"GA",null,"GEORGIA","Pima"]
[11,"",false,"","",10,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G22=\"child\",IF(((EffectiveDate-K22)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"HI","Yes","HAWAII","Pinal",null,null,"Ascend HMO Plus - PimaConnect Ntwk $8,000/$35/$100 (70%)","HMO",8000,35,70,"PNN","N","Y","Y","N"]
[12,"",false,"","",11,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G23=\"child\",IF(((EffectiveDate-K23)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"ID",null,"IDAHO","Santa Cruz",null,null,"Ascend HMO Plus - PimaConnect Ntwk $7,000/$25/$100 (70%)","HMO",7000,25,70,"PNN","N","Y","Y","N"]
[13,"",false,"","",12,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G24=\"child\",IF(((EffectiveDate-K24)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"IL",null,"ILLINOIS","Yavapai",null,null,"Ascend HMO Plus - PimaConnect Ntwk $6,000/$25/$75 (70%)","HMO",6000,25,70,"PNN","N","Y","Y","N"]
[14,"",false,"","",13,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G25=\"child\",IF(((EffectiveDate-K25)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"IN",null,"INDIANA","Yuma",null,null,"Ascend HMO Plus - PimaConnect Ntwk $5,000/$25/$75 (70%)","HMO",5000,25,70,"PNN","N","Y","Y","N"]
[15,"",false,"","",14,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G26=\"child\",IF(((EffectiveDate-K26)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"IA",null,"IOWA",null,null,null,"Ascend HMO Plus - PimaConnect Ntwk $3,000/$25/$60 (70%)","HMO",3000,25,70,"PNN","N","Y","Y","N"]
[16,"",false,"","",15,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G27=\"child\",IF(((EffectiveDate-K27)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"KS",null,"KANSAS",null,null,null,"Ascend HMO Plus - PimaConnect Ntwk $7,000/$25/$100 (80%)","HMO",7000,25,80,"PNN","N","Y","Y","N"]
[17,"",false,"","",16,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G28=\"child\",IF(((EffectiveDate-K28)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,"KY",null,"KENTUCKY",null,null,null,"Ascend HMO Plus - PimaConnect Ntwk $6,000/$25/$75 (80%)","HMO",6000,25,80,"PNN","N","Y","Y","N"]
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[70,"",false,"","",69,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G81=\"child\",IF(((EffectiveDate-K81)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $3,000 (80%/50%)","BPS",3000,0,80,"ALI","Y","N","Y","Y"]
[71,"",false,"","",70,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G82=\"child\",IF(((EffectiveDate-K82)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $6,000 (90%/50%)","BPS",6000,0,90,"ALI","Y","N","Y","Y"]
[72,"",false,"","",71,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G83=\"child\",IF(((EffectiveDate-K83)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $5,000 (90%/50%)","BPS",5000,0,90,"ALI","Y","N","Y","Y"]
[73,"",false,"","",72,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G84=\"child\",IF(((EffectiveDate-K84)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $4,000 (90%/50%)","BPS",4000,0,90,"ALI","Y","N","Y","Y"]
[74,"",false,"","",73,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G85=\"child\",IF(((EffectiveDate-K85)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $3,000 (90%/50%)","BPS",3000,0,90,"ALI","Y","N","Y","Y"]
[75,"",false,"","",74,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G86=\"child\",IF(((EffectiveDate-K86)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $7,000 (100%/100%)","BPS",7000,0,100,"ALI","Y","N","Y","Y"]
[76,"",false,"","",75,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G87=\"child\",IF(((EffectiveDate-K87)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $6,000 (100%/100%)","BPS",6000,0,100,"ALI","Y","N","Y","Y"]
[77,"",false,"","",76,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G88=\"child\",IF(((EffectiveDate-K88)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $5,000 (100%/100%)","BPS",5000,0,100,"ALI","Y","N","Y","Y"]
[78,"",false,"","",77,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G89=\"child\",IF(((EffectiveDate-K89)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $4,000 (100%/100%)","BPS",4000,0,100,"ALI","Y","N","Y","Y"]
[79,"",false,"","",78,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G90=\"child\",IF(((EffectiveDate-K90)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Alliance Ntwk $3,000 (100%/100%)","BPS",3000,0,100,"ALI","Y","N","Y","Y"]
[80,"",false,"","",79,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G91=\"child\",IF(((EffectiveDate-K91)/365)>25,\"Overage\",\"\"),\"\")","v":""}]
[81,"",false,"","",80,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G92=\"child\",IF(((EffectiveDate-K92)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $6,000 (70%/50%)","BPS",6000,"0",70,"PNN","Y","N","Y","Y"]
[82,"",false,"","",81,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G93=\"child\",IF(((EffectiveDate-K93)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $5,000 (70%/50%)","BPS",5000,"0",70,"PNN","Y","N","Y","Y"]
[83,"",false,"","",82,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G94=\"child\",IF(((EffectiveDate-K94)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $4,000 (70%/50%)","BPS",4000,"0",70,"PNN","Y","N","Y","Y"]
[84,"",false,"","",83,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G95=\"child\",IF(((EffectiveDate-K95)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $3,000 (70%/50%)","BPS",3000,"0",70,"PNN","Y","N","Y","Y"]
[85,"",false,"","",84,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G96=\"child\",IF(((EffectiveDate-K96)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $6,000 (80%/50%)","BPS",6000,"0",80,"PNN","Y","N","Y","Y"]
[86,"",false,"","",85,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G97=\"child\",IF(((EffectiveDate-K97)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $5,000 (80%/50%)","BPS",5000,"0",80,"PNN","Y","N","Y","Y"]
[87,"",false,"","",86,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G98=\"child\",IF(((EffectiveDate-K98)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $4,000 (80%/50%)","BPS",4000,"0",80,"PNN","Y","N","Y","Y"]
[88,"",false,"","",87,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G99=\"child\",IF(((EffectiveDate-K99)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $3,000 (80%/50%)","BPS",3000,"0",80,"PNN","Y","N","Y","Y"]
[89,"",false,"","",88,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G100=\"child\",IF(((EffectiveDate-K100)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $6,000 (90%/50%)","BPS",6000,"0",90,"PNN","Y","N","Y","Y"]
[90,"",false,"","",89,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G101=\"child\",IF(((EffectiveDate-K101)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $5,000 (90%/50%)","BPS",5000,"0",90,"PNN","Y","N","Y","Y"]
[91,"",false,"","",90,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G102=\"child\",IF(((EffectiveDate-K102)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $4,000 (90%/50%)","BPS",4000,"0",90,"PNN","Y","N","Y","Y"]
[92,"",false,"","",91,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G103=\"child\",IF(((EffectiveDate-K103)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $3,000 (90%/50%)","BPS",3000,"0",90,"PNN","Y","N","Y","Y"]
[93,"",false,"","",92,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G104=\"child\",IF(((EffectiveDate-K104)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $7,000 (100%/100%)","BPS",7000,"0",100,"PNN","Y","N","Y","Y"]
[94,"",false,"","",93,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G105=\"child\",IF(((EffectiveDate-K105)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $6,000 (100%/100%)","BPS",6000,"0",100,"PNN","Y","N","Y","Y"]
[95,"",false,"","",94,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G106=\"child\",IF(((EffectiveDate-K106)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $5,000 (100%/100%)","BPS",5000,"0",100,"PNN","Y","N","Y","Y"]
[96,"",false,"","",95,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G107=\"child\",IF(((EffectiveDate-K107)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $4,000 (100%/100%)","BPS",4000,"0",100,"PNN","Y","N","Y","Y"]
[97,"",false,"","",96,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G108=\"child\",IF(((EffectiveDate-K108)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - PimaConnect Ntwk $3,000 (100%/100%)","BPS",3000,"0",100,"PNN","Y","N","Y","Y"]
[98,"",false,"","",97,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G109=\"child\",IF(((EffectiveDate-K109)/365)>25,\"Overage\",\"\"),\"\")","v":""}]
[99,"",false,"","",98,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G110=\"child\",IF(((EffectiveDate-K110)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $6,000 (70%/50%)","BPS",6000,0,70,"001","Y","N","Y","Y"]
[100,"",false,"","",99,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G111=\"child\",IF(((EffectiveDate-K111)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $5,000 (70%/50%)","BPS",5000,0,70,"001","Y","N","Y","Y"]
[101,"",false,"","",100,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G112=\"child\",IF(((EffectiveDate-K112)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $4,000 (70%/50%)","BPS",4000,0,70,"001","Y","N","Y","Y"]
[102,"",false,"","",101,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G113=\"child\",IF(((EffectiveDate-K113)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $3,000 (70%/50%)","BPS",3000,0,70,"001","Y","N","Y","Y"]
[103,"",false,"","",102,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G114=\"child\",IF(((EffectiveDate-K114)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $6,000 (80%/50%)","BPS",6000,0,80,"001","Y","N","Y","Y"]
[104,"",false,"","",103,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G115=\"child\",IF(((EffectiveDate-K115)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $5,000 (80%/50%)","BPS",5000,0,80,"001","Y","N","Y","Y"]
[105,"",false,"","",104,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G116=\"child\",IF(((EffectiveDate-K116)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $4,000 (80%/50%)","BPS",4000,0,80,"001","Y","N","Y","Y"]
[106,"",false,"","",105,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G117=\"child\",IF(((EffectiveDate-K117)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $3,000 (80%/50%)","BPS",3000,0,80,"001","Y","N","Y","Y"]
[107,"",false,"","",106,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G118=\"child\",IF(((EffectiveDate-K118)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $6,000 (90%/50%)","BPS",6000,0,90,"001","Y","N","Y","Y"]
[108,"",false,"","",107,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G119=\"child\",IF(((EffectiveDate-K119)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $5,000 (90%/50%)","BPS",5000,0,90,"001","Y","N","Y","Y"]
[109,"",false,"","",108,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G120=\"child\",IF(((EffectiveDate-K120)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $4,000 (90%/50%)","BPS",4000,0,90,"001","Y","N","Y","Y"]
[110,"",false,"","",109,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G121=\"child\",IF(((EffectiveDate-K121)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $3,000 (90%/50%)","BPS",3000,0,90,"001","Y","N","Y","Y"]
[111,"",false,"","",110,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G122=\"child\",IF(((EffectiveDate-K122)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $1,500 (90%/50%)","BPS",1500,"0",90,"001","Y","N","Y","Y"]
[112,"",false,"","",111,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G123=\"child\",IF(((EffectiveDate-K123)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $7,000 (100%/100%)","BPS",7000,0,100,"001","Y","N","Y","Y"]
[113,"",false,"","",112,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G124=\"child\",IF(((EffectiveDate-K124)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $6,000 (100%/100%)","BPS",6000,0,100,"001","Y","N","Y","Y"]
[114,"",false,"","",113,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G125=\"child\",IF(((EffectiveDate-K125)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $5,000 (100%/100%)","BPS",5000,0,100,"001","Y","N","Y","Y"]
[115,"",false,"","",114,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G126=\"child\",IF(((EffectiveDate-K126)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $4,000 (100%/100%)","BPS",4000,0,100,"001","Y","N","Y","Y"]
[116,"",false,"","",115,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G127=\"child\",IF(((EffectiveDate-K127)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HSA Plus - Statewide Ntwk $3,000 (100%/100%)","BPS",3000,0,100,"001","Y","N","Y","Y"]
[117,"",false,"","",116,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G128=\"child\",IF(((EffectiveDate-K128)/365)>25,\"Overage\",\"\"),\"\")","v":""}]
[118,"",false,"","",117,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G129=\"child\",IF(((EffectiveDate-K129)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $8,000/$35/$100 (70%/50%)","BP",8000,35,70,"ALI","N","Y","Y","N"]
[119,"",false,"","",118,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G130=\"child\",IF(((EffectiveDate-K130)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $7,000/$25/$100 (70%/50%)","BP",7000,25,70,"ALI","N","Y","Y","N"]
[120,"",false,"","",119,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G131=\"child\",IF(((EffectiveDate-K131)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $6,000/$25/$75 (70%/50%)","BP",6000,25,70,"ALI","N","Y","Y","N"]
[121,"",false,"","",120,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G132=\"child\",IF(((EffectiveDate-K132)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $5,000/$25/$75 (70%/50%)","BP",5000,25,70,"ALI","N","Y","Y","N"]
[122,"",false,"","",121,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G133=\"child\",IF(((EffectiveDate-K133)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $4,000/$25/$60 (70%/50%)","BP",4000,25,70,"ALI","N","Y","Y","N"]
[123,"",false,"","",122,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G134=\"child\",IF(((EffectiveDate-K134)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $3,000/$25/$60 (70%/50%)","BP",3000,25,70,"ALI","N","Y","Y","N"]
[124,"",false,"","",123,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G135=\"child\",IF(((EffectiveDate-K135)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $1,000/$25/$50 (70%/50%)","BP",1000,25,70,"ALI","N","Y","Y","N"]
[125,"",false,"","",124,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G136=\"child\",IF(((EffectiveDate-K136)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $7,000/$25/$100 (80%/50%)","BP",7000,25,80,"ALI","N","Y","Y","N"]
[126,"",false,"","",125,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G137=\"child\",IF(((EffectiveDate-K137)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Alliance Ntwk $6,000/$25/$75 (80%/50%)","BP",6000,25,80,"ALI","N","Y","Y","N"]
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[151,"",false,"","",150,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G162=\"child\",IF(((EffectiveDate-K162)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $4,000/$25/$60 (80%/50%)","BP",4000,25,80,"PNN","N","Y","Y","N"]
[152,"",false,"","",151,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G163=\"child\",IF(((EffectiveDate-K163)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $3,000/$25/$60 (80%/50%)","BP",3000,25,80,"PNN","N","Y","Y","N"]
[153,"",false,"","",152,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G164=\"child\",IF(((EffectiveDate-K164)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $1,000/$25/$50 (80%/50%)","BP",1000,25,80,"PNN","N","Y","Y","N"]
[154,"",false,"","",153,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G165=\"child\",IF(((EffectiveDate-K165)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $6,000/$25/$75 (90%/50%)","BP",6000,25,90,"PNN","N","Y","Y","N"]
[155,"",false,"","",154,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G166=\"child\",IF(((EffectiveDate-K166)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $5,000/$25/$75 (90%/50%)","BP",5000,25,90,"PNN","N","Y","Y","N"]
[156,"",false,"","",155,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G167=\"child\",IF(((EffectiveDate-K167)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $4,000/$25/$60 (90%/50%)","BP",4000,25,90,"PNN","N","Y","Y","N"]
[157,"",false,"","",156,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G168=\"child\",IF(((EffectiveDate-K168)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $3,000/$25/$60 (90%/50%)","BP",3000,25,90,"PNN","N","Y","Y","N"]
[158,"",false,"","",157,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G169=\"child\",IF(((EffectiveDate-K169)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $8,300/$25/$95 (100%/100%)","BP",8300,25,100,"PNN","N","Y","Y","N"]
[159,"",false,"","",158,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G170=\"child\",IF(((EffectiveDate-K170)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $6,000/$25/$75 (100%/50%)","BP",6000,25,100,"PNN","N","Y","Y","N"]
[160,"",false,"","",159,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G171=\"child\",IF(((EffectiveDate-K171)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $5,000/$25/$75 (100%/50%)","BP",5000,25,100,"PNN","N","Y","Y","N"]
[161,"",false,"","",160,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G172=\"child\",IF(((EffectiveDate-K172)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $4,000/$25/$60 (100%/50%)","BP",4000,25,100,"PNN","N","Y","Y","N"]
[162,"",false,"","",161,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G173=\"child\",IF(((EffectiveDate-K173)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - PimaConnect Ntwk $3,000/$25/$60 (100%/50%)","BP",3000,25,100,"PNN","N","Y","Y","N"]
[163,"",false,"","",162,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G174=\"child\",IF(((EffectiveDate-K174)/365)>25,\"Overage\",\"\"),\"\")","v":""}]
[164,"",false,"","",163,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G175=\"child\",IF(((EffectiveDate-K175)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $8,000/$35/$100 (70%/50%)","BP",8000,35,70,"001","N","Y","Y","N"]
[165,"",false,"","",164,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G176=\"child\",IF(((EffectiveDate-K176)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $7,000/$25/$100 (70%/50%)","BP",7000,25,70,"001","N","Y","Y","N"]
[166,"",false,"","",165,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G177=\"child\",IF(((EffectiveDate-K177)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $6,000/$25/$75 (70%/50%)","BP",6000,25,70,"001","N","Y","Y","N"]
[167,"",false,"","",166,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G178=\"child\",IF(((EffectiveDate-K178)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $5,000/$25/$75 (70%/50%)","BP",5000,25,70,"001","N","Y","Y","N"]
[168,"",false,"","",167,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G179=\"child\",IF(((EffectiveDate-K179)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $4,000/$25/$60 (70%/50%)","BP",4000,25,70,"001","N","Y","Y","N"]
[169,"",false,"","",168,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G180=\"child\",IF(((EffectiveDate-K180)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $3,000/$25/$60 (70%/50%)","BP",3000,25,70,"001","N","Y","Y","N"]
[170,"",false,"","",169,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G181=\"child\",IF(((EffectiveDate-K181)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,500/$25/$60 (70%/50%)","BP",2500,25,70,"001","N","Y","Y","N"]
[171,"",false,"","",170,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G182=\"child\",IF(((EffectiveDate-K182)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,000/$25/$50 (70%/50%)","BP",2000,25,70,"001","N","Y","Y","N"]
[172,"",false,"","",171,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G183=\"child\",IF(((EffectiveDate-K183)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,500/$25/$50 (70%/50%)","BP",1500,25,70,"001","N","Y","Y","N"]
[173,"",false,"","",172,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G184=\"child\",IF(((EffectiveDate-K184)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,000/$25/$50 (70%/50%)","BP",1000,25,70,"001","N","Y","Y","N"]
[174,"",false,"","",173,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G185=\"child\",IF(((EffectiveDate-K185)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $7,000/$25/$100 (80%/50%)","BP",7000,25,80,"001","N","Y","Y","N"]
[175,"",false,"","",174,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G186=\"child\",IF(((EffectiveDate-K186)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $6,000/$25/$75 (80%/50%)","BP",6000,25,80,"001","N","Y","Y","N"]
[176,"",false,"","",175,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G187=\"child\",IF(((EffectiveDate-K187)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $5,000/$25/$75 (80%/50%)","BP",5000,25,80,"001","N","Y","Y","N"]
[177,"",false,"","",176,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G188=\"child\",IF(((EffectiveDate-K188)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $4,000/$25/$60 (80%/50%)","BP",4000,25,80,"001","N","Y","Y","N"]
[178,"",false,"","",177,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G189=\"child\",IF(((EffectiveDate-K189)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $3,000/$25/$60 (80%/50%)","BP",3000,25,80,"001","N","Y","Y","N"]
[179,"",false,"","",178,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G190=\"child\",IF(((EffectiveDate-K190)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,500/$25/$60 (80%/50%)","BP",2500,25,80,"001","N","Y","Y","N"]
[180,"",false,"","",179,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G191=\"child\",IF(((EffectiveDate-K191)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,000/$25/$50 (80%/50%)","BP",2000,25,80,"001","N","Y","Y","N"]
[181,"",false,"","",180,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G192=\"child\",IF(((EffectiveDate-K192)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,500/$25/$50 (80%/50%)","BP",1500,25,80,"001","N","Y","Y","N"]
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[183,"",false,"","",182,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G194=\"child\",IF(((EffectiveDate-K194)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $500/$25/$45 (80%/50%)","BP",500,25,80,"001","N","Y","Y","N"]
[184,"",false,"","",183,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G195=\"child\",IF(((EffectiveDate-K195)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $6,000/$25/$75 (90%/50%)","BP",6000,25,90,"001","N","Y","Y","N"]
[185,"",false,"","",184,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G196=\"child\",IF(((EffectiveDate-K196)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $5,000/$25/$75 (90%/50%)","BP",5000,25,90,"001","N","Y","Y","N"]
[186,"",false,"","",185,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G197=\"child\",IF(((EffectiveDate-K197)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $4,000/$25/$60 (90%/50%)","BP",4000,25,90,"001","N","Y","Y","N"]
[187,"",false,"","",186,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G198=\"child\",IF(((EffectiveDate-K198)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $3,000/$25/$60 (90%/50%)","BP",3000,25,90,"001","N","Y","Y","N"]
[188,"",false,"","",187,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G199=\"child\",IF(((EffectiveDate-K199)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,500/$25/$60 (90%/50%)","BP",2500,25,90,"001","N","Y","Y","N"]
[189,"",false,"","",188,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G200=\"child\",IF(((EffectiveDate-K200)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,000/$25/$50 (90%/50%)","BP",2000,25,90,"001","N","Y","Y","N"]
[190,"",false,"","",189,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G201=\"child\",IF(((EffectiveDate-K201)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,500/$25/$50 (90%/50%)","BP",1500,25,90,"001","N","Y","Y","N"]
[191,"",false,"","",190,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G202=\"child\",IF(((EffectiveDate-K202)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,000/$25/$50 (90%/50%)","BP",1000,25,90,"001","N","Y","Y","N"]
[192,"",false,"","",191,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G203=\"child\",IF(((EffectiveDate-K203)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $500/$25/$45 (90%/50%)","BP",500,25,90,"001","N","Y","Y","N"]
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[194,{"$f":"IF(G205=\"\",\"\",IF(CB205=\"Y\",0,IF(J205<>\"\",B204,IF(G205<>\"EMPLOYEE\",B204+1,B204+1))))","v":""},{"$f":"IF(TRIM(BP205)=\"Y\",IF(E204<>\"\",E204+1,C204))","v":false},"",{"$f":"IF(TRIM(G205)=\"\",IF(TRIM(G204)<>\"\",IF(TRIM(E204)<>\"\",E204+1,C205),IF(AND(BP205=\"Y\",W205<>\"\",W205<>\"Waive\"),C205,\"\")),IF(AND(BP205=\"Y\",W205<>\"\",W205<>\"Waive\"),C205,\"\"))","v":""},{"$f":"IF(TRIM(G205)<>\"\",IF(CB205=\"Y\",0,IF(TRIM(J205)<>\"\",\"\",B205)),IF(F204<>\"\",F204+1,B204+1))","v":193},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","",{"$f":"IF(TRIM(G205)<>\"\",IF(TRIM(BD204)<>\"\",BD204,\"\"),\"\")","v":""},"","","","","","","",{"$f":"IF(TRIM(G205)<>\"\",IF(CB205=\"Y\",\"Non Eligible\",IF(TRIM(BY205)=\"employee\",IF(J205<>\"\",VLOOKUP(J205,CN:CO,2,FALSE),VLOOKUP(T205,CI:CJ,2,FALSE)),IF(J205<>\"\",VLOOKUP(J205,CN:CO,2,FALSE),BZ205))),\"\")","v":""},"","","","","","","","","","","",0,"",{"$f":"IF(BY205<>\"\",IF(BY205=\"employee\",BL205,BZ204),\"\")","v":""},"","N","",{"$f":"IF(G205=\"child\",IF(((EffectiveDate-K205)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $8,300/$25/$95 (100%/100%)","BP",8300,25,100,"001","N","Y","Y","N"]
[195,"",false,{"$f":"IF(TRIM(D205)<>\"\",IF(OR(TRIM(D205)=\"1\",TRIM(D205)=\"0\"),\"\",D205-1),IF(AND(TRIM(U205)<>\"\",TRIM(U205)<>\"0\"),U205,\"\"))","v":""},"",194,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","",{"$f":"BP205","v":""},"","","","","","","",0,"","","",{"$f":"CB205","v":"N"},"",{"$f":"IF(G206=\"child\",IF(((EffectiveDate-K206)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $6,000/$25/$75 (100%/50%)","BP",6000,25,100,"001","N","Y","Y","N"]
[196,"",false,"","",195,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G207=\"child\",IF(((EffectiveDate-K207)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $5,000/$25/$75 (100%/50%)","BP",5000,25,100,"001","N","Y","Y","N"]
[197,"",false,"","",196,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G208=\"child\",IF(((EffectiveDate-K208)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $4,000/$25/$60 (100%/50%)","BP",4000,25,100,"001","N","Y","Y","N"]
[198,"",false,"","",197,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G209=\"child\",IF(((EffectiveDate-K209)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $3,000/$25/$60 (100%/50%)","BP",3000,25,100,"001","N","Y","Y","N"]
[199,"",false,"","",198,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G210=\"child\",IF(((EffectiveDate-K210)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,500/$25/$60 (100%/50%)","BP",2500,25,100,"001","N","Y","Y","N"]
[200,"",false,"","",199,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G211=\"child\",IF(((EffectiveDate-K211)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $2,000/$25/$50 (100%/50%)","BP",2000,25,100,"001","N","Y","Y","N"]
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[202,"",false,"","",201,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G213=\"child\",IF(((EffectiveDate-K213)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PPO - Statewide Ntwk $1,000/$25/$50 (100%/50%)","BP",1000,25,100,"001","N","Y","Y","N"]
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[216,"",false,"","",215,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G227=\"child\",IF(((EffectiveDate-K227)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"9. PPO 25-2000 A V2-9 Vol","DPPO",25,0,100,"001",null,null,null,null,"00000001000461","N"]
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[218,"",false,"","",217,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G229=\"child\",IF(((EffectiveDate-K229)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"11. PPO 50-1500 A90 V2-9 Vol","DPPO",50,0,100,"001",null,null,null,null,"00000001000463","N"]
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[221,"",false,"","",220,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N","N","N","N","N","","","","","","","","","","","","","","","","","","","","","",0,"","","","N","",{"$f":"IF(G232=\"child\",IF(((EffectiveDate-K232)/365)>25,\"Overage\",\"\"),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"14. DHMO High ","DHMO",0,0,100,"001",null,null,null,null,"00000001000185","N"]
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