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[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,CU:DF,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,CU:DF,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,{"$f":"IF(TRIM(U5)<>\"\",VLOOKUP(U5,CU:DF,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,"*Complete all yellow highlighted columns",null,null,null,null,null,null,"LPFSA:",null,null,"Plan 4",null,null,{"$f":"IF(OR(U6=\"Custom Dental 1\",U6=\"Custom Dental 2\",U6=\"Custom Dental 3\",U6=\"Custom Dental 4\"),\"X\",\"\")","v":""},null,null,null,{"$f":"IF(TRIM(U6)<>\"\",VLOOKUP(U6,CU:DF,12,FALSE),\"\")","v":""}]
[null,null,null,null,null,null,"*No blank rows between employees/families",null,null,null,null,null,null,null,null,null,"Plan 5",null,null,{"$f":"COUNTIF(T1:T6,\"=x\")","v":0}]
[null,null,null,null,null,null,"*When doing copy & paste follow the required format indicated",null,null,null,null,null,null,null,null,null,"Plan 6",null,null,"",null,null,null,{"$f":"IF(TRIM(U8)<>\"\",VLOOKUP(U8,CU:DF,12,FALSE),\"\")","v":""}]
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[3,"",false,{"$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","","","",{"$f":"IF(TRIM(G14)<>\"\",IF(TRIM(BY14)=\"employee\",IF(TRIM(R14)<>\"\",VLOOKUP(R14,CU:CV,2,FALSE),\"\"),BF13),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(TRIM(BY14)=\"employee\",IF(TRIM(R14)<>\"\",VLOOKUP(R14,CU:CZ,3,FALSE),\"\"),BG13),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(TRIM(BY14)=\"employee\",IF(TRIM(R14)<>\"\",VLOOKUP(R14,CU:CZ,4,FALSE),\"\"),BH13),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(TRIM(BY14)=\"employee\",IF(TRIM(R14)<>\"\",VLOOKUP(R14,CU:CZ,5,FALSE),\"\"),BI13),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(TRIM(BY14)=\"employee\",IF(TRIM(R14)<>\"\",VLOOKUP(R14,CU:CZ,6,FALSE),\"\"),BJ13),\"\")","v":""},"","","","","",{"$f":"BP13","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"waive\"),VLOOKUP(CA14,CU:CV,2,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"WAIVE\"),VLOOKUP(CA14,CU:CZ,3,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"WAIVE\"),VLOOKUP(CA14,CU:CZ,4,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"WAIVE\"),VLOOKUP(CA14,CU:CZ,5,FALSE),\"\"),\"\")","v":""},{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"WAIVE\"),VLOOKUP(CA14,CU:CZ,6,FALSE),\"\"),\"\")","v":""},"",{"$f":"IF(TRIM(G14)<>\"\",IF(AND(TRIM(W14)<>\"\",TRIM(W14)<>\"WAIVE\"),VLOOKUP(CA14,CU:DE,11,FALSE),\"\"),\"\")","v":""},0,"","","",{"$f":"CB13","v":"N"},{"$f":"IF(TRIM(W14)<>\"\",IF(TRIM(W14)<>\"waive\",IF(TRIM(X14)<>\"\",VLOOKUP(W14,CU:DF,12,FALSE),\"\"),\"\"),\"\")","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"]
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